Dual countertraction for extraction of abandoned leads with severe lead-to-lead adhesion.
Ontology highlight
ABSTRACT:
SUBMITTER: Toba M
PROVIDER: S-EPMC8637094 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundCardiac implantable electronic device (CIED) implantation rate has been increasing worldwide. Despite proper surgical technique and preincisional intravenous antibiotics, the incidence of infected CIED remains high and leads to serious complications. When encountered with CIED infection, complete CIED system removal is indicated. Several lead extraction approaches have shown a high success rate. However, the facilities are limited in Thailand. In our current practice, we perform lead extraction using the Dotter basket snare femoral approach as our primary method. There are no prior data on this countertraction-assisted transfemoral technique. Therefore, we aim to study the procedural outcome of countertraction-assisted transfemoral lead removal technique of CIED infection in Thai patients.MethodsPatients diagnosed with CIED infection and with a history of device infection were retrospectively included. Simple manual removal was performed. In case of failure, we proceeded with the modified countertraction-assisted transfemoral technique.ResultsThere were 35 patients in the study. The success rate was 94.3%. Most of the leads, 62.8%, were removed by simple manual traction. In the 37.1% who required further femoral approach lead extractions, procedural failure was observed in 5.7% and procedure-related adverse events in 5.6%. CIED infection-related death accounted for 5.7% and nosocomial infection-related death, 2.8%.ConclusionThe success rate of CIED infection lead explant and countertraction-assisted transfemoral lead extraction technique was high with small complications and can be performed without advanced facilities. However, the procedure required a main center with a cardiovascular thoracic surgery support team.
| S-EPMC8485811 | biostudies-literature
Project description:Atmospheric deposition samples were collected over 15 mo at several locations near an operating smelter and an abandoned Pb smelter to investigate the contribution of Pb smelting to depositional fluxes and potential local air quality degradation. Samples were analyzed for As, Cd, Cu, Pb, and Zn and subjected to scanning electron microscopy (SEM)-energy dispersive spectroscopy (EDS). Concentrations of Cd and Pb at both sites were greater than at the control site (p < .05), and significant correlations existed between Cd and Pb concentrations at both sites (p < .05). Monthly depositional flux variations at both sites were similar, with greater deposition during cold and dry periods. Heavy metal(loid)s deposition during these periods was correlated with wind speed. Greater Cd depositional flux differences were found between the smelter and control sites compared with other elements. The SEM images suggested that some particles at the operating smelter site were from Pb smelting material. However, most particles at both sites had no characteristics of smelting, suggesting reactions occurred between the smelter-emitted particles and soil components. The EDS results indicated that atmospheric deposition from both sites had lower Pb concentrations than smelting material or ash. The main atmospheric deposition source at the operating and abandoned sites was likely from the resuspension of heavy metal(loid)-enriched soil particles. Greater risk of air pollution from historical Pb smelting facilities exists years after closing down. Reducing soil wind erosional losses may help reduce heavy metal(loid)s dispersion across environments.
| S-EPMC7963641 | biostudies-literature
Project description:BackgroundThe incidence, predictors, and clinical impact of lead break during transvenous lead extraction (TLE) were previously unknown.MethodsWe included consecutive patients who underwent TLE between September 2013 and July 2019 at our institute. Lead break during removal was defined as lead stretching and becoming misshapen, as assessed by fluoroscopy.ResultsA total of 246 patients underwent TLE for 501 leads. At a patient level, complete success was achieved in 226 patients (91.9%). At a lead level, 481 leads (96.0%) were completely removed and 101 leads (20.1%) were broken during the procedure. Of 392 identified pacemaker leads, 71 (18.3%) were broken during the TLE procedure. A multivariable analysis confirmed high lead age (odds ratio [OR] 1.12, 95% confidence interval (CI) 1.07-1.17; P < .001), passive leads (OR 2.29 95% CI 1.09-4.80; P = .028), coradial leads (OR 3.45 95% CI 1.72-6.92; P < .001), and insulators made of nonpolyurethane (OR 2.38 95% CI 1.03-5.26; P = .04) as predictors of lead break. Broken leads needed longer procedure times and were associated with a higher rate of cardiac tamponade.ConclusionsLead age, coradial bipolar leads, passive leads, and leads without polyurethane insulation were predictors of lead break and could increase the difficulty of lead extraction.
| S-EPMC8207345 | biostudies-literature
Project description:PurposeThe risks of RF-induced heating of active implantable medical device (AIMD) leads during MR examinations must be well understood and realistically assessed. In this study, we evaluate the potential additional risks of broken and abandoned (cut) leads.MethodsFirst, we defined a generic AIMD with a metallic implantable pulse generator (IPG) and a 100-cm long lead containing 1 or 2 wires. Next, we numerically estimated the deposited in vitro lead-tip power for an intact lead, as well as with wire breaks placed at 10 cm intervals. We studied the effect of the break size (wire gap width), as well as the presence of an intact wire parallel to the broken wire, and experimentally validated the numeric results for the configurations with maximum deposited in vitro lead-tip power. Finally, we performed a Tier 3 assessment of the deposited in vivo lead-tip power for the intact and broken lead in 4 high resolution virtual population anatomic models for over 54,000 MR examination scenarios.ResultsThe enhancement of the deposited lead-tip power for the broken leads, compared to the intact lead, reached 30-fold in isoelectric exposure, and 16-fold in realistic clinical exposures. The presence of a nearby intact wire, or even a nearby broken wire, reduced this enhancement factor to <7-fold over the intact lead.ConclusionBroken and abandoned leads can pose increased risk of RF-induced lead-tip heating to patients undergoing MR examinations. The potential enhancement of deposited in vivo lead-tip power depends on location and type of the wire break, lead design, and clinical routing of the lead, and should be carefully considered when performing risk assessment for MR examinations and MR conditional labeling.
| S-EPMC8362172 | biostudies-literature
Project description:Bacterial diversity in mine tailing microbial communities has not been thoroughly investigated despite the correlations that have been observed between the relative microbial diversity and the success of revegetation efforts at tailing sites. This study employed phylogenetic analyses of 16S rRNA genes to compare the bacterial communities present in highly disturbed, extremely (pH 2.7) and moderately (pH 5.7) acidic lead-zinc mine tailing samples from a semiarid environment with those from a vegetated off-site (OS) control sample (pH 8). Phylotype richness in these communities decreased from 42 in the OS control to 24 in the moderately acidic samples and 8 in the extremely acidic tailing samples. The clones in the extremely acidic tailing sample were most closely related to acidophiles, none of which were detected in the OS control sample. The comparison generated by this study between the bacteria present in extremely acidic tailing and that in moderately acidic tailing communities with those in an OS control soil provides a reference point from which to evaluate the successful restoration of mine tailing disposal sites by phytostabilization.
| S-EPMC2446573 | biostudies-literature
Project description: Not available
| S-EPMC5989134 | biostudies-literature
Project description:The infection rates of implanted cardiac devices have increased disproportionate to the dramatic increase in implantation rates, possibly related to rising patient comorbidities. Optimum strategy in cases with larger size vegetations, however, remains to be ascertained. In the absence of an effective and less invasive alternative, such patients usually undergo open thoracotomy for lead extraction. We describe the case of a 50-year-old female presenting with recurrent methicillin-resistant Staphylococcus aureus bacteremia found to have 3 cm highly mobile vegetation on the right ventricular lead of her implanted defibrillator. While being intermediate-to-low surgical risk, she underwent AngioVac-directed suction debulking (AngioDynamics, Latham, NY, USA) of the vegetation simultaneously preceding percutaneous laser lead extraction in a single session. This less invasive alternative to open thoracotomy has been described in high surgical risk patients, but its widespread role remains unexplored. <Learning objective: Complete lead extraction is recommended in all cases of lead infection. However in the presence of large-size lead vegetation, the optimum management strategy is still controversial, especially among high-risk surgical patients. AngioVac system (AngioDynamics, Latham, NY, USA) has a centrifugal suction cannula which can offer a safer and less invasive percutaneous alternative to open thoracotomy approach, with a possibility of large-scale application due to faster recovery.>.
| S-EPMC6149661 | biostudies-literature
Project description: Not available
| S-EPMC7805125 | biostudies-literature
Project description:In 2013, Klity Creek became the site of Thailand's first legally required remediation, 15 years after the spill of lead (Pb)-contaminated mine tailings into the creek. Even today, nature cannot attenuate Pb-contaminated sediment, arguably due to either high geological background Pb or continuous leakage of Pb from the unlined tailing ponds, upstream of the creek. In this study, four lines of evidence were used to reveal that the leakage from tailing ponds is primarily responsible for the long-term Pb contamination. First, stable Pb isotope ratios (206Pb/207Pb and 208Pb/207Pb) were used to apportion sources between the tailings and geological background. The analysis of samples from the tailing ponds, geological background, and local zinc (Zn)-Pb deposit revealed five different Pb sources (i.e., two distinct mine tailings, two different backgrounds, and a local Zn-Pb deposit) in the area based on five unique isotope ratios. Using source apportionment analysis, Pb-contaminated sediments in Klity Creek were consistent with tailings being the dominant source (30%-100%). Likewise, an analysis of Pb radionuclide (210Pb) revealed the Pb in the contaminated sediment was relatively new, 0-6.7 years old, suggesting that the Pb source was recent leakage from the tailing ponds rather than the 15-year-old tailing spill. Isotope evidence was supported by the elevated Pb-contaminated seepage (0.30 ± 0.22 mg/L) from the tailing ponds and groundwater samples (up to 0.225 mg/L) collected from monitoring wells surrounding the tailing ponds. Consequently, proper management of Pb leakage from the tailing ponds is critical for successful Klity Creek remediation.
| S-EPMC8101536 | biostudies-literature
Project description:Pacemaker lead extractors must become familiar with transfemoral approaches for lead extraction as a bail-out procedure for a failed superior approach. We presented a "tetra-axial" system for transfemoral lead extraction. This system would be more widely applicable in cases with difficulties in extraction, resulting in more procedural success.
| S-EPMC5458036 | biostudies-literature