TY  - JOUR
T1  - Transvenous Extraction of Spontaneously Fractured Leads with Migrated Proximal Ends: Techniques and Outcomes
A1  - Daniel Fischer
A1  - Laura Meier
A1  - Thomas Braun
A1  - Stefan Koch
A1  - Felix Roth
JF  - Bulletin of Pioneering Researches of Medical and Clinical Science
JO  - Bull Pioneer Res Med Clin Sci
SN  - 3006-2659
Y1  - 2026
VL  - 6
IS  - 1
DO  - 10.51847/oVTd0vjY4b
SP  - 70
EP  - 85
N2  - The extraction of spontaneously fractured pacemaker or defibrillator leads whose proximal segments have migrated into the vascular system has received limited detailed analysis to date. This study was designed to evaluate and compare the efficacy of various extraction techniques and supporting tools for fractured leads with migrated proximal ends. A retrospective review was performed on 72 cases selected from a total database of 3847 transvenous lead extraction (TLE) procedures. The majority of the extracted leads were passive-fixation models, particularly unipolar ones. These procedures were highly complex; nevertheless, the overall success rate remained strong at 93.06% and was not dependent on the exact location of the proximal end during migration. Major complications occurred in 2.78% of cases, a rate that may be linked to the extended implant duration of 152.2 months. Removal of these leads showed no impact on patients’ long-term survival. The femoral approach was the most commonly utilized method, applied in 62.50% of cases. Mechanical dissection tools were necessary in 79.16% of the leads. In 66.7% of procedures, the proximal end was tightly adhered to the vessel wall, requiring the creation of a loop for extraction. Additionally, in 15.28% of cases, the lead was coiled around a pigtail catheter using the so-called “spaghetti twisting technique.” (1) Spontaneous fracture of a lead with migration of the proximal end into the vascular space is uncommon, accounting for only 1.87% of all TLE procedures. (2) Successful removal of such leads demands a variety of extraction approaches combined with both specialized and standard tools. (3) Although these procedures are highly complex, they achieve good effectiveness with an acceptable incidence of major complications.
UR  - https://bprmcs.com/article/transvenous-extraction-of-spontaneously-fractured-leads-with-migrated-proximal-ends-techniques-and-ymp1v7mrglscuwg
ER  -