Figure 2 Four examples of infections of too shallow CIED
pockets. The lead loop (A) or the edge of the unit (B, C, D) causes
progressive skin necrosis and secondary classic infection. Examples of
situations where it is much too late for surgical ”plastic pocket
surgery” and the only solution is to remove the infected system
completely.
In our large database of 3706 patients who underwent TLE in the years
2006-until now, 60 patients with too shallow pocket were identified. In
60% of patients in this group, the main indication for TLE was
CED-related infection (in 30% local, pocket infection). Among the
non-infectious indications, the dominant ones were: lead dysfunctions
caused by their mechanical damage and other causes (20% in total).
Consistent with guidelines for indications for transvenous lead
extraction, a too shallow pocket is not the primary cause of TLE (Table
1).