title: Use of the mechanical dilator sheath for removal of endocardial leads: a single center experience.
abstract: BACKGROUND
  Due to an increasing number of cardiac device implantations, the number of leads that need to be extracted because of infection or lead failure is consistently rising. We present our experience in percutaneous lead removal in a single tertiary center.
  
  
  METHODS
  From December 2009 to August 2010, 12 patients underwent percutaneous lead extraction procedure by the Evolution™ mechanical dilator sheath (Cook Medical Inc., Bloomington, IN, USA) system after failure of manual traction and a locking stylet.
  
  
  RESULTS
  Ages of the patients ranged between 7 and 86 years (mean age was 58 ± 12 years). Mean implantation time was 73 months (range between 12 and 244 months). Ten patients had one lead; only two patients had two leads. Indications for lead removal were: lead endocarditis in five patients, local (pocket) infection in four patients, and lead failure in three patients. All leads were successfully removed by using the device, except one lead which was one of the two leads in a patient with dual chamber pacemaker implanted 10 years ago. In three patients, same venous accesses (sheath of extraction system) were used to implant a new lead after removal of damaged leads without a new venous puncture. In only one patient, significant hematoma was found after the intervention and treated conservatively. No other significant complications were encountered in any patients.
  
  
  CONCLUSIONS
  Damaged or infected leads can safely and relatively easily be extracted by using this new percutaneous extraction technique.
authors.affiliation: Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Aksu
authors.forename: Umit
authors.initials: U
authors.lastname: Guray
authors.forename: Taner
authors.initials: T
authors.lastname: Sen
authors.forename: Mine
authors.initials: M
authors.lastname: Durukan
authors.forename: Yesim
authors.initials: Y
authors.lastname: Guray
authors.forename: Burcu
authors.initials: B
authors.lastname: Demirkan
authors.forename: Halil
authors.initials: H
authors.lastname: Kisacik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D020878:Device Removal / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D004699:Endocardium / Q000601:surgery*; D004867:Equipment Design; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016896:Treatment Outcome; D055815:Young Adult