title: Prevalence of venous occlusion in patients referred for lead extraction: implications for tool selection.
abstract: OBJECTIVE
  Data concerning the incidence of venous obstruction in patients referred for lead extraction is limited. Thus, we aimed to assess the incidence of venous obstruction in patients referred for lead extraction and the implications for tool selection.
  
  
  RESULTS
  Contrast venography of the access vein was obtained in 202 patients (147 men; mean age, 62.4 ± 14.5 years) scheduled for lead extraction. The indication for lead extraction included infection (n = 145, 72%) and other causes (n = 57, 28%). Two patients with device infection had superior vena caval occlusion. Access vein occlusion occurred in 6 (11%) patients without infection vs. 46 (32%) patients with infection [P = 0.002; odds ratio (OR) 3.94; 95% confidence interval (CI) 1.58-9.87]. No significant differences between occluded and non-occluded patients were seen for age, sex, device type, number of leads, time from implant of the initial lead, or anticoagulation therapy (all P>0.05). Procedural duration and fluoroscopy exposure time were significantly lower in the open group than in the occluded group (P < 0.05). Patients with venous occlusion required more advanced tools for lead extraction, such as dilator sheaths, evolution sheaths, and needle's eye snares (P = 0.019).
  
  
  CONCLUSIONS
  Both systemic and local infections are associated with increased risk of access vein occlusion. We found no support for the hypothesis that venous occlusion increases with the number of leads present. Lead extraction was more difficult in patients with venous occlusion, requiring advanced tools and more time.
authors.affiliation: Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, No. 22, Xinling Road, Shantou City, Guangdong, 515000, China Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.
authors.forename: Xuebin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Ze
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China.
authors.forename: Long
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China.
authors.forename: Jiangbo
authors.initials: J
authors.lastname: Duan
authors.affiliation: Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, No. 22, Xinling Road, Shantou City, Guangdong, 515000, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China.
authors.forename: Cuizhen
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, No. 22, Xinling Road, Shantou City, Guangdong, 515000, China guojihongpku@163.com docyuguang.li@gmail.com.
authors.forename: Yuguang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China guojihongpku@163.com docyuguang.li@gmail.com.
authors.forename: Jihong
authors.initials: J
authors.lastname: Guo
mesh_terms: D015984:Causality; D002681:China / Q000453:epidemiology; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D020878:Device Removal / Q000295:instrumentation* / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D011859:Radiography; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: Infection; Lead extraction; Pacemaker leads; Phlebography; Venous occlusion