James Clark, Abbas Zaidi, Peter O’Callaghan, Ulrich von Oppell, Andrew SP Sharp
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We report the use of a single access aspiration system using the Inari Flowtriever 24 French system to debulk a defibrillator lead before percutaneous extraction.\n \n \n \n A 79-year-old male presented with fever 18 years after his first implantable cardioverter defibrillator implant and 9 years after his most recent pulse generator change. Two large vegetations were identified on his transvenous defibrillator lead on the atrial aspect, near the tricuspid annulus, which were aspirated using the Inari Medical 24Fr FlowTriever aspiration catheter. We describe anatomical considerations during the approach and a technique to localise the vegetations based on a combination of fluoroscopy and TEE guidance.\n \n \n \n This case demonstrates the safe and effective use of the Inari Medical 24Fr Flowtriever aspiration catheter in debulking a defibrillator lead before transvenous lead extraction. This method uses a single venous puncture and is not dependent on extracorporeal bypass. Apart from reducing complexity, this technique may be advantageous in patients where anticoagulation needs to be minimised.\n","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"X marks the spot - Catheter aspiration using the Inari Flowtriever device to debulk defibrillator lead vegetations prior to transvenous lead extraction- A case report\",\"authors\":\"James Clark, Abbas Zaidi, Peter O’Callaghan, Ulrich von Oppell, Andrew SP Sharp\",\"doi\":\"10.1093/ehjcr/ytae332\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"\\n \\n \\n When cardiac implantable electronic device infection occurs, standard therapy is usually total system extraction. Transvenous lead extraction is preferable to open heart surgical extraction, unless contraindicated because of the presence of very large vegetations on the intravenous leads according to ESC guidance. Extraction of transvenous leads with vegetations risks distal embolism resulting in obstruction and/or infection in the pulmonary arteries. Catheter aspiration of vegetations or thrombi has been performed prior to transvenous lead extraction using a partial veno-venous extracorporeal bypass circuit. We report the use of a single access aspiration system using the Inari Flowtriever 24 French system to debulk a defibrillator lead before percutaneous extraction.\\n \\n \\n \\n A 79-year-old male presented with fever 18 years after his first implantable cardioverter defibrillator implant and 9 years after his most recent pulse generator change. Two large vegetations were identified on his transvenous defibrillator lead on the atrial aspect, near the tricuspid annulus, which were aspirated using the Inari Medical 24Fr FlowTriever aspiration catheter. We describe anatomical considerations during the approach and a technique to localise the vegetations based on a combination of fluoroscopy and TEE guidance.\\n \\n \\n \\n This case demonstrates the safe and effective use of the Inari Medical 24Fr Flowtriever aspiration catheter in debulking a defibrillator lead before transvenous lead extraction. This method uses a single venous puncture and is not dependent on extracorporeal bypass. 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引用次数: 0
摘要
当发生心脏植入式电子设备感染时,标准疗法通常是全系统拔除。根据 ESC 指南,经静脉导联拔除术优于开胸手术拔除术,除非因静脉导联上存在非常大的植被而有禁忌症。抽取带有植被的经静脉导联有可能造成远端栓塞,导致肺动脉阻塞和/或感染。在使用部分静脉-静脉体外旁路回路抽取经静脉导联之前,已对植被或血栓进行了导管抽吸。我们报告了使用 Inari Flowtriever 24 French 系统的单通道抽吸系统,在经皮抽取除颤器导联线之前对其进行清创的情况。 一名 79 岁的男性在首次植入心律转复除颤器 18 年后和最近一次更换脉冲发生器 9 年后出现发热。在他的经静脉除颤器导联线的心房侧、三尖瓣环附近发现了两个大的植被,使用 Inari Medical 24Fr FlowTriever 抽吸导管对其进行了抽吸。我们介绍了手术过程中的解剖学注意事项,以及基于透视和 TEE 引导的植物定位技术。 本病例展示了在经静脉抽取除颤器导联线之前安全有效地使用 Inari Medical 24Fr Flowtriever 抽吸导管清除导联线杂质的方法。这种方法只需一次静脉穿刺,不依赖于体外旁路。除了降低复杂性外,这种技术对于需要尽量减少抗凝治疗的患者也很有优势。
X marks the spot - Catheter aspiration using the Inari Flowtriever device to debulk defibrillator lead vegetations prior to transvenous lead extraction- A case report
When cardiac implantable electronic device infection occurs, standard therapy is usually total system extraction. Transvenous lead extraction is preferable to open heart surgical extraction, unless contraindicated because of the presence of very large vegetations on the intravenous leads according to ESC guidance. Extraction of transvenous leads with vegetations risks distal embolism resulting in obstruction and/or infection in the pulmonary arteries. Catheter aspiration of vegetations or thrombi has been performed prior to transvenous lead extraction using a partial veno-venous extracorporeal bypass circuit. We report the use of a single access aspiration system using the Inari Flowtriever 24 French system to debulk a defibrillator lead before percutaneous extraction.
A 79-year-old male presented with fever 18 years after his first implantable cardioverter defibrillator implant and 9 years after his most recent pulse generator change. Two large vegetations were identified on his transvenous defibrillator lead on the atrial aspect, near the tricuspid annulus, which were aspirated using the Inari Medical 24Fr FlowTriever aspiration catheter. We describe anatomical considerations during the approach and a technique to localise the vegetations based on a combination of fluoroscopy and TEE guidance.
This case demonstrates the safe and effective use of the Inari Medical 24Fr Flowtriever aspiration catheter in debulking a defibrillator lead before transvenous lead extraction. This method uses a single venous puncture and is not dependent on extracorporeal bypass. Apart from reducing complexity, this technique may be advantageous in patients where anticoagulation needs to be minimised.