title: Transvenous extraction of pacemaker and implantable cardioverter defibrillator leads using Evolution® mechanical dilator sheath: a single center confirmatory experience.
abstract: OBJECTIVE
  In recent years there has been an increase in clinical situations requiring lead extraction procedures of implanted cardiac devices. In our clinic, extraction procedures are performed with Evolution® mechanical lead extraction system. In this manuscript we aimed to evaluate our lead extraction procedures.
  
  
  METHODS
  We retrospectively evaluated lead extraction procedures carried out on 41 patients [30 male, 11 female patient; mean age 61.5 ± 18.5 median 67 (23-85)] between 2008 and 2015 using Evolution® system. Procedural success, major and minor complications are determined according to previously published guidelines.
  
  
  RESULTS
  Mean duration of the lead implantation was 88.4 ± 62.5 months (6-240). Implanted device was a pacemaker in 27 (65.8 %) and ICD in 14 (34.2 %) of patients. Total 67 leads were extracted from the patients, 22 (32.8 %) were atrial, 30 (44.2 %) were ventricular, 14 (21.5 %) were dual coil defibrillator and 1 (1.5 %) was coronary sinus lead. Indications for lead removal were pacemaker decubitis and infection in 29 (70.8 %), lead dysfunction in 11 (26.8 %) and subclavian vein thrombosis in 1 (2.4 %) patient. Success rate with Evolution® system without using snare was 85.3 %. Clinical success rate was 97.5 % procedural success rate was 95.1 % and failure occured in one patient. Major complications occured in 2 (4.8 %) patients, 1 (2.4 %) was procedure related mortality. Minor complications were seen in 5 (12.2 %) of patients.
  
  
  CONCLUSIONS
  In our single center study it is shown that extraction of pacemaker and defibrillator leads of relatively long implantation duration and in an older age patient group may be successfully carried out using the Evolution® system. However due to potentially serious complications it is adviced to be done by experienced operators in centers with cardiovascular surgery backup.
authors.affiliation: Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey.
authors.forename: Uğur
authors.identifier: 0000-0001-9868-206X
authors.initials: U
authors.lastname: Kocabaş
authors.affiliation: Cardiology Department, Medical Faculty, Near East University, Nicosia, Cyprus.
authors.forename: Hamza
authors.initials: H
authors.lastname: Duygu
authors.affiliation: Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey.
authors.forename: Nihan Kahya
authors.initials: NK
authors.lastname: Eren
authors.affiliation: Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey.
authors.forename: Zehra İlke
authors.initials: Zİ
authors.lastname: Akyıldız
authors.affiliation: Cardiology Department, Farabi Hospital, Konya, Turkey.
authors.forename: Serhan
authors.initials: S
authors.lastname: Özyıldırım
authors.affiliation: Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey.
authors.forename: Selcen Yakar
authors.initials: SY
authors.lastname: Tülüce
authors.affiliation: Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey.
authors.forename: Tuncay
authors.initials: T
authors.lastname: Kırış
authors.affiliation: Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Nazlı
keywords: Defibrillator; Extraction; Lead; Pacemaker