This was a right-sided lead extraction procedure to remove two cardiac leads due to cied pocket infection.The ra epicardial lead was extracted using an lld-ez and a 14f glidelight.It was noted during the extraction of the ra lead that there was difficulty progressing with the glidelight in the area of the subclavian and svc junction.This difficulty was also noted during the extraction of the rv lead.Higher settings (fluence and rate) were used in this area, however the glidelight was not able to get through.The glidelight was then removed and it was noted that the laser sheath was damaged (red light was visible through the sheath).The physician then used a cook evolution mechanical sheath, however it was not able to progress through the same area.It was noted at this time that the patient began to bleed, however the physician did not believe it to be urgent.Another 14f glidelight was used, however there was difficulty progressing in the same area again.Upon removal of the catheter, damage to the outer insulation was noted again (similar to first glidelight).The patient began to bleed more heavily and a sternotomy was performed.Two holes in the subclavian vein were found and repaired.Due to the complexity of the case and the injury that occurred, the physician elected to cut and cap the ra lead and abandon the lld inside the lead.The plan is to perform another lead extraction via a femoral approach at a later date to extract the abandoned lead and lld.The patient stabilized and was sent to recovery following the procedure.This report is being filed for the lld requiring situational abandonment inside the patient's vasculature.
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