• Khaldoun G Tarakji, Walid Saliba, Danny Markabawi, E Rene Rodriguez, Yoaav Krauthammer, Michael P Brunner, Ayman A Hussein, Bryan Baranowski, Daniel J Cantillon, Mohamed Kanj, Mark Niebauer, Jack Rickard, Thomas Callahan, Mingyuan Shao, David O Martin, Oussama M Wazni, Bruce L Wilkoff, and Carmela D Tan.
• Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: tarakjk@ccf.org.
• Heart Rhythm. 2018 Mar 1; 15 (3): 318-325.

BackgroundThe major complication rate of transvenous lead extraction (TLE) is estimated to be 1%-2%. Laceration of the central veins can be fatal.ObjectivesTo define the incidence and extent of venous injuries on a microscopic level after TLE and compare these data with those of clinically documented events of venous laceration.MethodsWe studied all patients who underwent TLE at our tertiary center within 30 months via a variety of techniques. Extracted leads and tissue around them were fixed in formalin. Pathologic examination was standardized to examine the leads identifying the areas covered by tissue cuffs along the length of the lead. The cuffs were removed and sectioned transversely to their longitudinal axis. Microscopic examination was performed using hematoxylin and eosin stains and Movat stains to identify the presence of vein tissue.ResultsIn all, 861 leads (585 pacemaker and 272 defibrillator leads) were extracted from 461 patients (median age 63 years, standard deviation 15 years), with an average of 1.9 leads per patient and a median lead age of 2546 days. On microscopic review, 80 leads (9.3%) in 72 of 461 patients (15.6%) showed segments of vein, most of which were transmural (venous tissue including adventitia). Despite this finding, only 5 catastrophic complications (1.1%) occurred that required emergent surgical intervention. Risk factors for venous injury included implantable cardioverter defibrillator lead, age of lead, and the use of laser sheath.ConclusionsMicroscopic venous injuries during lead extraction are common but often not recognized clinically.Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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