The following is a summary of “Venous Occlusion Detected By Computed Tomography Is Associated With Transvenous Lead Extraction Difficulty,” published in the March 2023 issue of Cardiology by Patel, et al.
For a study, researchers sought to determine the ability of cardiac computed tomography (CT) to predict the difficulty of transvenous lead extraction procedures.
The study included all consecutive patients who underwent transvenous lead extraction at UCSD between January 2018 and February 2022. A pre-procedural cardiac-gated chest CT was performed on all patients. A radiologist analyzed the CT to evaluate the presence of venous occlusion, superior vena cava, brachiocephalic binding sites, and lead embedment in the vessel wall. Multivariable linear and logistic regression analyses were performed to identify predictors of lead extraction difficulty based on CT and clinical characteristics such as fluoroscopy time per extracted lead and the need for a mechanical sheath.
A total of 343 consecutive patients were included, with a mean age of 63.8 ± 15.4 years and 71% male. The mean lead dwell time was 102.7 ± 68.4 months. In multivariable linear regression analysis, vessel occlusion detected on CT was independently associated with increased fluoroscopy time (P<0.001, β=0.14, CI:0.8-4.8) and the need for a mechanical sheath (P<0.001, β=3.8, CI:1.9-7.8), even after adjusting for clinical characteristics such as lead dwell time.
The study found that venous occlusion identified by cardiac CT is independently associated with the increased difficulty of lead extraction, regardless of expected clinical predictors.