International Journal of Vascular Surgery and Medicine eertechz Citation: Bongiorni MG, Coluccia G, Segreti L, Paperini L, Soldati E (2015) Effective Percutaneous Repositioning of an Active Fixation ICD Lead. Int J Vasc Surg Med 1(1): 004-006. 004 Abstract We report a case of effective trans catheter repositioning of an ICD lead that was displaced during a trans venous extraction procedure of another malfunctioning ICD lead. This original technique was effective also in screwing-in the active ixation tip of the lead. Skilled operators could take into account this technique to avoid the re-opening of the device pocket, when dealing with speciic situations at high risk of infection. ventricular ejection fraction. No other relevant comorbidities were known. he patient presented to our attention with two leads: the abandoned dual-coil lead and the single-coil malfunctioning lead (Kainox RV-S 75, Biotronik, Berlin, Germany), that was targeted for TLE (Figure 1A). he indication for TLE raised ater evidence of signiicantly decreased shock impedance, from the chronic values around 65 Ohm, to 29 Ohm. Lead dwelling time was twelve years and a procedure of TLE with concomitant new system implantation was planned under general anesthesia. Fibrous adherences in the venous tree were very robust. Single- sheath mechanical dilatation from let subclavian venous entry side in superior vena cava, right atrium (RA) and ventricle (RV) was really challenging. During dilatation, the lead was broken in several points and its remaining extravascular portion was minimal. We decided to cross over to an internal transjugular approach. A delectable diagnostic catheter was advanced from the let femoral vein and used to grasp the lead in the RA; at this point, the lead was completely intravascular and was then exteriorized from the right internal jugular vein, using two Lasso catheters to catch its externalized cables [1,2]. Abbreviations TLE: Transvenous Lead Extraction; ICD: Implantable Cardio verter Deibrillator; RA: Right Atrium; RV: Right Ventricle; Case Presentation A 74-years-old male patient was referred to our Institution for transvenous extraction (TLE) of a malfunctioning deibrillator (ICD) lead. Patient’s clinical history reported a previous episode of aborted sudden cardiac death, occurred two years ater an anterior acute myocardial infarction and a subsequent surgical revascularization. Ater resuscitation, the patient underwent coronary angiography, which showed no possibility ofurther percutaneous or surgical revascularization. A single-chamber ICD system was implanted. hree years later, the occurrence of inappropriate shocks revealed a lead malfunction, unsuccessfully treated with extraction: the lead was abandoned and a new one was implanted. In the follow-up, the patient presented appropriate ICD shocks, despite a 50% let Case Report Efective Percutaneous Repositioning of an Active Fixation ICD Lead Maria Grazia Bongiorni, Giovanni Coluccia*, Luca Segreti, Luca Paperini and Ezio Soldati Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital, Pisa, Italy Dates: Received: 24 April, 2015; Accepted: 26 May, 2015; Published: 28 May, 2015 *Corresponding author: Giovanni Coluccia, MD, Second Cardiology Division, University Hospital of Pisa, Via Paradisa, 2 - 56100 PISA Italy, Tel: +39050993043; Fax: +39050992352; E-mail: www.peertechz.com Keywords: Lead extraction; ICD lead; Percutaneous repositioning; Displaced lead; Pigtail catheter Figure 1: Panel A: chest X-ray at admission, showing the abandoned dual coil lead and the malfunctioning single-coil ICD lead. Panel B: the new active ixation ICD lead is implanted.