spielmar
New
My MD attempted to upgrade a dual-chamber pacemaker to a dual-chamber ICD.
Old generator and leads were freed from adhesions
with careful dissection by electrocautery. Generator was taken out of pocket.
Left upper extremity venogram was done with high suspicious for total occlusion of left subclavian vein however there appeared to be a microchannel and multiple attempts were made to cannulate this channel. On repeat imaging at a more caudal projection, what appeared to be microchannel ended up being a collateral which could not be cannulated and accessed after multiple attempts.
Hence given patient age, safety of his chronic leads, risk of pneumothorax on multiple accesses, decision was made to close the case without having being able to successfully upgrade his device. Pacemaker pocket however was extended inferiorly and medially for a better position and hence pocket revision was done.
Leads were connected to the old generator and cleaned with wet and dry sponges.
The generator was placed in pocket with TYRX puch and the pocket was irrigated with antibiotic/saline solution.
The pocket was closed with multiple layers of absorbable suture and steri-strips
with a sterile dressing were applied.
Postprocedure testing revealed baseline sensing impedances and thresholds.
It doesn't look like he removed the leads, just freed them from adhesions. Only the generator was removed and put back in so I was thinking maybe 33228?? The MD chose 33222 & 33249 but I don't agree.
Any help would be appreciated!
Thank you,
Rita M
Old generator and leads were freed from adhesions
with careful dissection by electrocautery. Generator was taken out of pocket.
Left upper extremity venogram was done with high suspicious for total occlusion of left subclavian vein however there appeared to be a microchannel and multiple attempts were made to cannulate this channel. On repeat imaging at a more caudal projection, what appeared to be microchannel ended up being a collateral which could not be cannulated and accessed after multiple attempts.
Hence given patient age, safety of his chronic leads, risk of pneumothorax on multiple accesses, decision was made to close the case without having being able to successfully upgrade his device. Pacemaker pocket however was extended inferiorly and medially for a better position and hence pocket revision was done.
Leads were connected to the old generator and cleaned with wet and dry sponges.
The generator was placed in pocket with TYRX puch and the pocket was irrigated with antibiotic/saline solution.
The pocket was closed with multiple layers of absorbable suture and steri-strips
with a sterile dressing were applied.
Postprocedure testing revealed baseline sensing impedances and thresholds.
It doesn't look like he removed the leads, just freed them from adhesions. Only the generator was removed and put back in so I was thinking maybe 33228?? The MD chose 33222 & 33249 but I don't agree.
Any help would be appreciated!
Thank you,
Rita M