Femoral-superior lead extraction complicated by venous dissection in chronic venous occlusion: How the alligator saved the day

Figures

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  Figure 1. Preoperative chest radiograph with implanted dual-chamber pacemaker.

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  Figure 2. Digital subtraction angiography via the left cubital vein showing total chronic occlusion of the left subclavian vein.

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  Figure 3. Intraoperative phlebography of the left subclavian vein via the rotating sheath after removing the ventricular pacing lead, showing extensive venous dissection from the left subclavian vein to the superior vena cava.

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  Figure 4. A rotation dissection sheath is advanced over the atrial lead with simultaneous counter-traction using an endoscopy alligator forceps advanced via the right femoral vein. A tight vertically oriented rail is created with a favorable angle between the superior vena cava and the tip of the mechanical rotating dilator sheath.

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  Figure 5. Postoperative chest radiograph with a functional DDD implantable cardioverter-defibrillator system. The tip of the extracted ventricular lead can be appreciated at the superior aspect of the superior vena cava.

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  Figure 6. A: Endoscopy alligator forceps introduced into a 10F coronary sinus sheath grasping an implantable cardioverter-defibrillator lead, which was extracted using a 13F rotating dilator sheath. B: Alligator forceps with open prongs and tip of a 10F coronary sinus sheath.