Cardiac pacemaker electrodes: improved methods of extraction. Work in progress.

PURPOSE: To develop improved methods of extracting pacemaker electrodes from the femoral vein by using standard equipment and techniques. MATERIALS AND METHODS: Pacemaker electrodes were removed from 61 patients aged 21-91 years (mean, 68 years). In 25 patients (41%), traction was applied to locking stylets to remove electrodes at the subclavian vein entry site. In 30 patients, the electrode tip was freed with traction at the subclavian vein entry site. The electrode was then extracted through a sheath placed in the femoral vein. In six patients (10%), the electrode tip was freed via the femoral vein when traction was applied to grasping devices. The electrode was then removed through a femoral venous sheath. RESULTS: Ninety-nine (95%) of 104 pacemaker electrodes were extracted completely. Two electrodes were trapped in fibrous tissue in the subclavian vein. One right atrial tear occurred. CONCLUSION: Pacemaker electrodes can be removed effectively by using percutaneous techniques.

Pulmonary artery false aneurysms secondary to Swan-Ganz pulmonary artery catheters.

Several complications from the use of balloon-tipped flow-directed (Swan-Ganz) pulmonary artery catheters are recognized. One infrequent but life-threatening complication is false aneurysm formation associated with rupture or dissection of the pulmonary artery. We report 10 cases of catheter-induced pulmonary artery false aneurysms identified during a 9-year period. Initial presentation was radiologic in six patients and clinical (hemoptysis) in four. Later chest radiographic findings consisted of a well-defined, persistent pulmonary nodule or mass (three patients) or focal, dense parenchymal consolidation (six patients) that either persisted (two patients) or evolved into a nodule or mass (four patients) adjacent to the catheter tip. Cavitation of a pulmonary mass developed in one case. Two of eight deaths were caused by pulmonary artery false aneurysm formation and rupture with subsequent fatal hemorrhage. In one patient who survived, the false aneurysm was shown by pulmonary angiography and embolized with coils and Gelfoam. We conclude that pulmonary artery false aneurysms are life-threatening complications of pulmonary artery catheters and have characteristic chest radiographic findings.

Steel coil embolization of hepatoportal fistulae.

Two patients with portal hypertension secondary to hepatoportal fistulae, of nontraumatic origin, were treated by transcatheter embolization of feeding hepatic artery branches with Gianturco-Anderson-Wallace steel coils. Both patients demonstrated immediate improvement of the symptoms related to their portal hypertension, 1 patient needing no further treatment after 3 years. It is concluded that using steel coils for this purpose is more effective and safer than other materials such as Gel-foam, and may cure portal hypertension in some cases.

Angioplasty of subclavian artery stenosis proximal to the vertebral origin.

Percutaneous transluminal angioplasty was performed in nine patients with symptomatic proximal left subclavian artery stenoses. All cases were technically successful. One significant delayed complication occurred in a patient whose common carotid-to-subclavian artery bypass graft occluded several months after a successful subclavian artery angioplasty with a probable subsequent embolic occlusion of the internal carotid artery. The other patients were asymptomatic after follow-up evaluations of 4-23 months.

Staged bilateral thoracotomies for multiple pulmonary arteriovenous malformations complicating hereditary hemorrhagic telangiectasia.

A patient with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) with multiple bilateral pulmonary arteriovenous malformations was hypoxic, cyanotic, polycythemic, and severely limited by dyspnea on exertion. Following staged bilateral thoracotomies, with removal of 23 major fistulas (12 from the right lung and 11 from the left), marked improvement in symptoms, blood gases, and objective measurements of exercise tolerance occurred.

The roentgenologic diagnosis of chronic bronchitis: a reassessment with emphasis on parahilar bronchi seen end-on.

In an attempt to reassess the accuracy of the roentgenologic diagnosis of chronic bronchitis, we have studied the chest radiographs of approximately 300 men comprising roughly equal numbers of normal subjects and patients with chronic obstructive pulmonary disease (COPD). Emphasis has been placed on the thickness of bronchial walls visualized end-on in the parahilar zones, identified in roughly 80% of both groups. Step-wise discriminant analysis of six variables showed that the median estimate of bronchial wall thickness was of some value in discrimination.