A Case of Arterial and Venous Tear during Single Lead Extraction
Transcutaneous lead extraction can be associated with significant morbidity and mortality. The risk of causing concomitant arterial and venous injury is rare. We report a case of marginal artery rupture with coronary sinus rupture after a CS lead extraction. A 71-year-old male was admitted for extra...
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doaj-76b484c73e044091b46029139666faca2020-11-25T00:04:03ZengHindawi LimitedCase Reports in Cardiology2090-64042090-64122016-01-01201610.1155/2016/38367543836754A Case of Arterial and Venous Tear during Single Lead ExtractionMichael S. Green0Daniel Wu1Vishal Patel2Rayhan Tariq3Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USADepartment of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USADepartment of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USADepartment of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USATranscutaneous lead extraction can be associated with significant morbidity and mortality. The risk of causing concomitant arterial and venous injury is rare. We report a case of marginal artery rupture with coronary sinus rupture after a CS lead extraction. A 71-year-old male was admitted for extraction of a 6-year-old implantable cardioverter-defibrillator lead due to fracture from insulation break. During the lead extraction, blood pressure fell precipitously and echocardiographic findings were consistent with pericardial effusion. After unsuccessful pericardiocentesis, open chest sternotomy and evacuation of hematoma was performed. Subsequent surgical repair of several injuries was completed including the distal coronary sinus, a large degloving injury of posterior portion of the heart, and first obtuse marginal branch bleed. This case demonstrates that when performing transcutaneous lead extraction (TLE) with laser sheath, a degloving injury can cause arterial rupture with concomitant coronary sinus injury. A multidisciplinary team-based approach can ensure patient safety. Learning Objective. Implantable cardioverter-defibrillator leads will falter over time. With the advancement of new technology for extraction more frequent and serious complications will occur. Active fixation CS leads present unique challenges. In the presence of hemodynamic changes during extraction the occurrence of both an arterial and venous injury must be considered.http://dx.doi.org/10.1155/2016/3836754 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Michael S. Green Daniel Wu Vishal Patel Rayhan Tariq |
spellingShingle |
Michael S. Green Daniel Wu Vishal Patel Rayhan Tariq A Case of Arterial and Venous Tear during Single Lead Extraction Case Reports in Cardiology |
author_facet |
Michael S. Green Daniel Wu Vishal Patel Rayhan Tariq |
author_sort |
Michael S. Green |
title |
A Case of Arterial and Venous Tear during Single Lead Extraction |
title_short |
A Case of Arterial and Venous Tear during Single Lead Extraction |
title_full |
A Case of Arterial and Venous Tear during Single Lead Extraction |
title_fullStr |
A Case of Arterial and Venous Tear during Single Lead Extraction |
title_full_unstemmed |
A Case of Arterial and Venous Tear during Single Lead Extraction |
title_sort |
case of arterial and venous tear during single lead extraction |
publisher |
Hindawi Limited |
series |
Case Reports in Cardiology |
issn |
2090-6404 2090-6412 |
publishDate |
2016-01-01 |
description |
Transcutaneous lead extraction can be associated with significant morbidity and mortality. The risk of causing concomitant arterial and venous injury is rare. We report a case of marginal artery rupture with coronary sinus rupture after a CS lead extraction. A 71-year-old male was admitted for extraction of a 6-year-old implantable cardioverter-defibrillator lead due to fracture from insulation break. During the lead extraction, blood pressure fell precipitously and echocardiographic findings were consistent with pericardial effusion. After unsuccessful pericardiocentesis, open chest sternotomy and evacuation of hematoma was performed. Subsequent surgical repair of several injuries was completed including the distal coronary sinus, a large degloving injury of posterior portion of the heart, and first obtuse marginal branch bleed. This case demonstrates that when performing transcutaneous lead extraction (TLE) with laser sheath, a degloving injury can cause arterial rupture with concomitant coronary sinus injury. A multidisciplinary team-based approach can ensure patient safety. Learning Objective. Implantable cardioverter-defibrillator leads will falter over time. With the advancement of new technology for extraction more frequent and serious complications will occur. Active fixation CS leads present unique challenges. In the presence of hemodynamic changes during extraction the occurrence of both an arterial and venous injury must be considered. |
url |
http://dx.doi.org/10.1155/2016/3836754 |
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