Lead extraction case to extract four cardiac leads due to cied system infection.The first two leads (1188 ra pacing and 1246 rv pacing, both implanted 216 months) were prepped with an lld #2.Extraction began on the left side and a laser sheath with outer teflon sheath was used, however progress stalled at the area of the clavicle.A cook dilating sheath was then used, followed by a visisheath and a cook evolution, however none of the devices were able to cross.A cook byrd dilator sheath was then used to successfully advance.A combinaton of cook dilating sheath and laser catheter failed to go beyond the most superior margins of the svc.At that time, because the leads were falling apart, the physician moved to the leads on the right side.These two leads (5076 ra pacing and 5076 rv pacing, both implanted 120 months) were prepped with a cook liberator and an lld-ez and extracted successfully.The physician then decided to extract the left-sided leads using a femoral approach.A cook femoral workstation was prepared and extraction on the left-sided leads was resumed about an hour after the previous attempt.Upon advancing and maneuvering the cook workstation, a drop in blood pressure was noted.An effusion was noted, a pericardiocentesis was performed, and within 10 minutes the physician had access to the heart where an injury was found and repaired in the innominate.The patient survived the intervention.Two llds required situational abandonment secondary to the injury and rescue.
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