Unusual complication of pacemaker implantation/revision: Secondary endocarditis due to fracture and embolization of an introducer sheath

PGY-2 Internal Medicine, Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee 37920, USA.
Catheterization and Cardiovascular Interventions (Impact Factor: 2.11). 02/2012; 79(2):339-43. DOI: 10.1002/ccd.22981
Source: PubMed


We report a 48-year-old male with a rare complication of pacemaker revision-fracture, migration, and secondary endocarditis due to a venous introducer sheath. We illustrate the possible mechanism of injury and discuss approaches to management.

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    ABSTRACT: Background: Many techniques for the endovascular retrieval of lost or misplaced foreign objects have been developed, and the removal of almost every foreign object has become possible. In this paper, we report our experience in retrieving foreign objects lost during cardiac device implantations or previous extraction procedures. Methods: This study was a retrospective analysis of the case records of all patients referred to our institution for transvenous retrieval of intravascular foreign objects. Results: Over 10 years, 45 consecutive patients underwent procedures for the retrieval of intravascular foreign objects. These objects were: 25 distal portions of introducer sheaths, 18 pacing lead fragments, one guidewire, and one anchoring sleeve. The majority of fragments were located in the right ventricle and subclavian and caval veins. Some had migrated to the pulmonary artery or more distally. The median dwell time of the fragments was 3 months. Retrieval was most frequently achieved through the femoral veins, and was successful in 42 (93%) procedures. No procedure-related complications occurred in this series. Conclusions: In the present single-center experience, the endovascular approach to retrieving intravascular objects lost during cardiac device implantation or previous extraction procedures seemed effective with currently available tools and was associated with no complications.
    Full-text · Article · May 2013 · Pacing and Clinical Electrophysiology