Key result
Laser-assisted transvenous lead extraction was successfully performed by the femoral route with video-assisted thoracoscopic monitoring to ensure safety and avoid full sternotomy.
Case Report (n=1)
No
Video-assisted thoracoscopic monitoring during femoral laser lead extraction may provide a safe, minimally invasive alternative to full sternotomy in high-risk cases.
Successful VATS extraction after laser-induced fracture demonstrates technical feasibility in occluded veins; leaves open standardization in complex cases.
A 72-year-old man with a dual-chamber implantable defibrillator was referred to our center for transvenous lead extraction because of pocket infection and presence of an abandoned lead. We decided to proceed with a video-assisted thoracoscopic approach because of patient history and documented complete occlusion of the right subclavian vein. During the use of excimer laser for persistent adhesions, the ventricular lead broke down at the level of cavoatrial junction. To successfully remove the remaining portion of lead, we decided to use the excimer laser by femoral route. A final angiography through the laser sheath showed the integrity of the myocardial wall. We report a case of laser-assisted transvenous lead extraction unconventionally performed by the femoral route. A preventive minimally invasive cardiac surgery was implemented to provide more safety in this high-risk procedure. This technique may avoid the need of a full sternotomy in case of major bleeding complications.
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Bontempi et al. (2018) conducted a case report in Pocket infection and abandoned lead in a patient with a dual-chamber implantable defibrillator (n=1). Video-assisted thoracoscopic monitoring of laser lead extraction by femoral route was evaluated on Successful removal of the remaining portion of lead. Laser-assisted transvenous lead extraction was successfully performed by the femoral route with video-assisted thoracoscopic monitoring to ensure safety and avoid full sternotomy.
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