Contrast venography before lead extraction may be desirable to ensure venous patency and identify abnormal lead locations, such as extravascular placement from unintentional venous puncture.
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May support pre-extraction venography to detect extravascular leads; case report leaves open routine adoption.
Spurious discharges due to late insulation break in an IS-1 pacing/sensing connector prompted ICD lead removal in 65-year-old man. The tip of the lead was easily freed and pulled back into the SVC by the superior approach. After that, the lead became trapped. The distal part of the lead was caught and easily withdrawn by inferior approach. Superior venous angiography showed extravascular location of the entrapped part of the lead due to the unintentional percutaneous puncture of the innominate vein after piercing the subclavian vein. It may be desirable to use contrast venography before intervention of extraction to ensure venous patency and lead location.
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Marrazzo et al. (2003) studied this question.
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