AUTHOR=Milman Anat , Leshem Eran , Massalha Eias , Jia Karen , Meitus Amit , Kariv Saar , Shafir Yuval , Glikson Michael , Luria David , Sabbag Avi , Beinart Roy , Nof Eyal 

TITLE=Occluded vein as a predictor for complications in non-infectious transvenous lead extraction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1016657

DOI=10.3389/fcvm.2022.1016657

ISSN=2297-055X

ABSTRACT=Background
Cardiovascular implantable electronic device (CIED) use is steadily increasing, and complications include venous occlusion and fractured leads. Transvenous Lead Extraction (TLE) can facilitate re-implantation of new leads.   
Aims
To explore predictors and complications of non-infectious TLE. 
Methods
A retrospective analysis and comparison of characteristics, complications, and outcomes of patients with and without occluded veins (OV) undergoing TLE at our center.
Results
Eighty-eight patients underwent TLE for non-infectious reasons. Indications for TLE were lead malfunction (62; 70.5%) and need for CIED upgrade (22; 25%). Fourteen patients referred due to lead malfunction had an OV observed during venography. 
The OV group (36 patients) were significantly older (65.7±14.1 vs 53.8±15.9 respectively, p=0.001) and had more comorbidities. EF was significantly lower for the OV group (27.5% vs 57.5%, p=0.001) as was longer lead dwelling time (3226±2324 vs 2191±1355 days, respectively, p=0.012). 
Major complications were exclusive for the OV group (5.5% vs none, p=0.17), and most minor complications occurred in the OV group as well (33.3% vs 4.1% respectively, p<0.001). Laser sheath and Mechanical tools for TLE were frequently used for OV as compared to the non-occluded group (94.4% vs 73.5% respectively, p=0.012). Procedure success was higher in the non-occluded group compared to the OV group (98% vs 83.3%, respectively, p=0.047). Despite these results, peri-procedural mortality was similar between groups. 
Conclusions 
Among TLE for non-infectious reasons, vein occlusion appears as a major predictor for complex TLE tools use, complications, and procedural success.  Venography should be considered prior to non-infectious TLE to identify high-risk patients.