Percutaneous lead extraction of cardiovascular implantable electronic devices. Use of diagnostic image techniques for a safe approach

The removal of cardiac pacing devices is a safe technique in experienced hands, with a complication rate between 0.5-15%. These complications should be known and always taken into account by the operator, so it is always useful to prevent them or, at least, minimize their consequences. The aim of this work is to highlight the usefulness of imaging techniques as diagnostic Con tecnologia de Editorial Manager((R)) y ProduXion Manager((R)) de Aries Systems Corporation tools that allow us to perform a safe approach in the extraction of devices, analyzing their essential characteristics. Conventional chest X-ray provides information on the state of the generator and electrodes (number, type of electrode, fixation, state and route). Axial computed tomography reveals the intravascular path of the electrodes, possible perforations in cardiac chambers, obstruction in the superior vena cava and associated pathology. Positron emission tomography (PET-CT) helps us to diagnose in some cases an uncertain infection. Intraoperative echocardiography allows a dynamic recording of the cardiac cavities, detecting early eversions under traction of the RV and valvular or cardiac ruptures that may occur during the procedure. Thoracoscopy also allows early diagnosis of vascular (subclavian, innominate trunk and superior cava) or cardiac complications under direct vision. Finally, with Augmented Reality we obtain 3D images that we superimpose with those obtained by fluoroscopy, identifying loops and adhesions very easily.In conclusion, imaging techniques are an essential aid in preventing complications during percutaneous extraction and, should they occur, to act quickly accordingly. (c) 2023 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).