title: Incidence, management, and outcomes of the arteriovenous fistula complicating transvenous lead extraction.
abstract: BACKGROUND
  An arteriovenous (AV) fistula is an infrequently reported complication of transvenous lead extraction (TLE), but may be under-recognized.
  
  
  OBJECTIVE
  To determine the incidence, management, and outcomes of the AV fistula complicating TLE.
  
  
  METHODS
  All TLE procedures from July 2001 to December 2012 were reviewed.
  
  
  RESULTS
  Of 2471 patients who underwent TLE, the AV fistula occurred in 8 (0.3%; 6 pacemaker and 2 implantable cardioverter-defibrillator) procedures. Patients who developed an AV fistula had longer lead implant duration (11.8 [interquartile range 7.7] vs 5.2 [interquartile range 7.0] years) and were more likely to have required a powered sheath (8 of 8 [100%] vs 1392 of 2463 [56.5%]) compared to those who did not. Other procedural and demographic details did not discriminate. All patients had a continuous bruit along the anterior chest wall. Catheter angiography was more sensitive (100%) than computed tomography (75%) or ultrasound (25%) for confirming the diagnosis and identifying the vessels involved. One fistula closed spontaneously, while others were closed with covered stents (4) or surgical glue (1). One attempt at closure failed, and one was diagnosed postmortem. Mortality related to the AV fistula was 3 of 8 (37.5%). Patients who died all had structural heart disease. In the 5 patients with normal hearts, the AV fistula was well tolerated for up to 2 years.
  
  
  CONCLUSIONS
  An AV fistula is an infrequent, though possibly under-recognized, complication of TLE. It requires a high index of suspicion for early diagnosis, may present late, and may be associated with significant morbidity and mortality in patients with structural heart disease.
authors.affiliation: Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Edmond M
authors.initials: EM
authors.lastname: Cronin
authors.affiliation: Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Brunner
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Carmela D
authors.initials: CD
authors.lastname: Tan
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: E
authors.initials: E
authors.lastname: Rene Rodriguez
authors.affiliation: Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.affiliation: Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
authors.affiliation: Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Khaldoun G
authors.initials: KG
authors.lastname: Tarakji
authors.affiliation: Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
authors.affiliation: Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio. Electronic address: baranob@ccf.org.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Baranowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D020878:Device Removal; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: Arteriovenous fistula; Implantable cardioverter-defibrillator (ICD); Pacemaker; Transvenous lead extraction