Lead extraction: "Drag Through" technique
Gupta, Anoop K (2002) Lead extraction: "Drag Through" technique. Indian Pacing and Electrophysiology Journal, 2 (4). pp. 95-96. ISSN 0972-6292
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The goal of extraction techniques of chronic pacemaker and defibrillator leads is to present an approach that is successful in extracting all leads and minimizes or eliminates complications. To extract a chronically implanted intravascular device, the device must be separated from the encapsulating inflammatory tissue. Three ablation techniques are currently used: mechanical, laser and electrosurgical. Indirect traction is traction applied by an instrument such as a snare passed into the heart, usually through a femoral vein. The lead is entrapped in the snare, and pulling or pushing applies traction. 1,2 The safety of this technique is enhanced by the ability to avoid those problems associated with the binding sites in the superior veins and right atrium. Indirect traction is more successful than direct traction. Countertraction is a method of safely extracting an electrode entrapped in fibrous tissue at the electrode-myocardial interface. It is defined as the countering of the traction on the lead by a sheath. A sheath of slightly larger diameter is passed over the lead to a point about 1 cm from the heart wall. Traction is applied on the lead, pulling the myocardial wall to the edge of the sheath, which counters the traction. Because only the scar tissue is present between the sheath and the heart wall, cardiac tissue is not in jeopardy.
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