title: Trans-venous lead removal without the use of extraction sheaths, results of >250 removal procedures.
abstract: OBJECTIVE
  The number of implanted cardiac rhythm devices has rapidly increased in the past decade. Subsequently, the need for lead extraction has also increased. Several techniques of lead removal have been documented from manual traction of the lead to lead extraction assisted with mechanical or laser sheaths. The goal of this study was to review our experience with lead removal using manual traction without the assistance of extraction sheaths.
  
  
  RESULTS
  In the Leiden University Medical Center all leads are removed using manual traction without the assistance of extraction sheaths. We have retrospectively reviewed all lead removal procedures performed between 2000 and 2009. Procedures were reviewed for indication, success, complication rates, and mortality. In total, 279 lead removal procedures were included. During these procedures 445 leads were removed. Time since lead implantation: 4.2 ± 4.7 years. During extraction 53(11.9%) leads fractured, of which >50% could still be completely removed using a femoral approach. A longer implantation duration [odds ratio (OR) 1.16 per year, 95% confidence interval (CI) 1.09-1.23] and passive fixation (OR 2.52, 95%CI 1.17-5.45) significantly associated with the chance of lead fracture during lead removal. Clinical success, using the primary approach of manual traction from the pectoral area, was obtained in 228 (84.8%) procedures. Major complications occurred in 2(0.7%) and minor in 13(4.7%) procedures. One patient died within 24 h after the procedure due to septic shock. There was no further mortality within the first month after the procedure.
  
  
  CONCLUSIONS
  Lead removal using manual traction, without the assistance of lead extraction sheaths, is clinically successful in ~85% of the lead extraction procedures. Concomitant morbidity and mortality are low. The highest clinical success (~95%) was observed in patients with leads implanted less than 2.6 years.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, PO box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Mihály K
authors.initials: MK
authors.lastname: de Bie
authors.forename: Doaa A
authors.initials: DA
authors.lastname: Fouad
authors.forename: C Jan Willem
authors.initials: CJ
authors.lastname: Borleffs
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Rees
authors.forename: Joep
authors.initials: J
authors.lastname: Thijssen
authors.forename: Serge A
authors.initials: SA
authors.lastname: Trines
authors.forename: Marianne
authors.initials: M
authors.lastname: Bootsma
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Lieselot
authors.initials: L
authors.lastname: van Erven
mesh_terms: D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome