title: Surgical management of major intrathoracic hemorrhage resulting from high-risk transvenous pacemaker/defibrillator lead extraction.
abstract: A method, based on well-established trauma principles, is described for surgical management of serious intrathoracic bleeding complications that can occur during the extraction of pacemaker or defibrillator leads. Using this method, four patients who experienced rapid hemodynamic deterioration due to traumatic injury of the superior vena cava and its tributaries during defibrillator lead extraction underwent successful surgical repair. Perioperative preparation for high-risk lead extractions, management of major bleeding complications, and surgical repair techniques are discussed. Major bleeding complications can be managed effectively with this strategy leading to excellent overall success rates for extractions without mortality.
authors.affiliation: Department of Surgery, Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Justine M
authors.initials: JM
authors.lastname: Caniglia-Miller
authors.forename: Walter D
authors.initials: WD
authors.lastname: Bussey
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Kamtz
authors.forename: Shane F
authors.initials: SF
authors.lastname: Tsai
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Erickson
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Anderson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Moulton
mesh_terms: D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D019990:Perioperative Care; D012306:Risk; D013896:Thoracic Diseases / Q000209:etiology* / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000293:injuries / Q000601:surgery