Internal Transjugular Approach

We use the internal transjugular approach (Fig. 4.28) as a first choice for free-floating leads and as an additional step for difficult leads when mechanical dilatation is ineffective or risky [8, 46]. In the presence of free-floating leads, this approach results in 

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Love CJ et al (2000) Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 23(4 Pt. 1) 544-551 

Wilkoff BL et al (2009) Transvenous lead extraction Heart Rhythm Society Expert consensus on facilities, training, indications, and patient management this document was endorsed by the American Heart Association (AHA). Heart Rhythm 6(7) 1085-1104 

Robboy SJ et al (1969) Autopsy findings with permanent pervenous pacemakers. Circulation 39(4) 495-501 

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It seems more accurate not to use the terms superior or inferior approach and, instead, to use the terms venous entry (implant vein) approach, transfemoral vein approach, and internal transjugular approach. In fact, the term superior approach can be misleading considering that either venous entry approach or internal transjugular approach can be considered superior approaches. 

Fig 4 21 Approaches for transvenous lead extraction venous entry approach using the implant vein (a), transfemoral approach (b), internal transjugular approach (c)... 

Table 4 9Lead extraction internal transjugular approach Tools... 

How to Perform Internal Transjugular Approach if Venous Entry Approach Fails... 

Fig 5 15 Internal transjugular approach (Pisa approach). Note the straight course of the sheath over the lead, increasing efficacy and safety of adherence dilatation... 

The internal transjugular approach was successful in 59 free-floating and 187 exposed leads as crossover from the venous entry approach. In two patients, due to failure to cannulate either the right or the left internal jugular vein, we used the right subclavian vein. Using this approach, 246 leads were completely removed. The procedure was partially successful in seven leads and unsuccessful in two. In the group with exposed leads, the approach increased the success rate from 90.3% to 98.3%. 

Bongiomi MG, Soldati E, Grana M et al (1997) The internal transjugular approach a new technique for transvenous lead removal. Proceedings of Third International Symposium on Pacing Leads Sept 11-13, 1997, Vol 1. Monduzzi Editore, Italy, pp 487 90... 

From Simple Traction to Internal Transjugular Approach... 

Fig 1.5 This patient was referred to our institution for lead extraction using the internal transjugular venous approach. The fractured lead ( ) was implanted in 1975. Note that the old lead has an electrode with a broader stimulating electrode surface area. Temporary pacing lead (°)... 

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