Simultaneous lead extraction and vacuum-assisted vegetation removal

The incidence of infection associated with cardiac implantable electronic devices (CIEDs) is rising at a rate faster than that of the number of implants. CIED infections typically require complete device and lead removal. The prevalence of vegetations is high in patients with infective indications who are referred for lead extraction. Because of the risk of hemodynamically significant pulmonary embolism associated with percutaneous lead extraction techniques, management of those with large lead vegetations continues to be challenging. Often, patients with vegetations larger than 20 mm in diameter are referred for consideration of open surgical lead extraction and debridement. We report a case of a patient with large lead vegetations in whom percutaneous lead extraction was performed with concomitant percutaneous removal of the vegetations using the AngioVac aspiration system (AngioDynamics Inc, Latham, NY).