1. Volume 15, Issue 3, Pages 318-325 (March 2018)
Unrecognized venous injuries after cardiac implantable electronic device transvenous lead extraction 
Khaldoun G. Tarakji, MD, MPH, FHRS, Walid Saliba, MD, FHRS, Danny Markabawi, MD, E. Rene Rodriguez, MD, Yoaav Krauthammer, MD, Michael P. Brunner, MD, FHRS, Ayman A. Hussein, MD, FHRS, Bryan Baranowski, MD, FHRS, Daniel J. Cantillon, MD, FHRS, Mohamed Kanj, MD, FHRS, Mark Niebauer, MD, FHRS, Jack Rickard, MD, FHRS, Thomas Callahan, MD, FHRS, Mingyuan Shao, MS, David O. Martin, MD, MPH, Oussama M. Wazni, MD, FHRS, Bruce L. Wilkoff, MD, FHRS, Carmela D. Tan, MD 
Heart Rhythm 
Volume 15, Issue 3, Pages (March 2018)
DOI: /j.hrthm
Copyright © 2017 Heart Rhythm Society Terms and Conditions

2. Heart Rhythm 2018 15, 318-325DOI: (10.1016/j.hrthm.2017.11.008)
Copyright © 2017 Heart Rhythm Society Terms and Conditions

3. Figure 1 Fibrous cuffs around extracted leads.
Heart Rhythm  , DOI: ( /j.hrthm )
Copyright © 2017 Heart Rhythm Society Terms and Conditions

4. Figure 2
Findings from histologic examination of fibrous cuffs surrounding cardiac implantable electronic device leads (Movat pentachrome stains). A: A section of the tissue cuff around the lead shows a thin rim of dense fibrous tissue stained in yellow with attached organizing thrombus stained in red (asterisk). The empty space in the center is the space occupied by the lead. B: Calcification (arrows) is common in the fibrous cuffs (with higher frequency in the areas over defibrillator coils), as shown in this example. C: This tissue cuff shows granulation tissue surrounding the empty space previously occupied by the lead. The tissue cuff is adherent to a transmural section of vein on the right side. Adjacent to the vein is a segment of skeletal muscle (asterisk). This finding is most consistent with tissue close to the pocket access site. D: The fibrous cuff shown in this section is focally surrounded by myocardial tissue with the myocytes stained in red (asterisk). This finding is common in the right ventricular apical leads and less common in the areas of contact with atrial myocardium. E: A thick fibrous cuff is densely adherent to the endocardium. A higher magnification of the boxed area of the endocardium is shown in F. A high-resolution version of the image is available as eSlide:VM F: The endocardium is thickened with a band of smooth muscle cells, fibrosis, and proliferation of abundant elastic fibers stained black (asterisk). Note the presence of a few blood vessels in the deeper layer and cautery artifact with the tissue at the edge staining dark brown black. Endocardial fibroelastosis could be mistaken for a segment of vein. However, in most instances, there are subtle differences in the characteristics of the elastic fibers that are finer in caliber and denser with a wavy pattern in endocardial fibroelastosis.
Heart Rhythm  , DOI: ( /j.hrthm )
Copyright © 2017 Heart Rhythm Society Terms and Conditions

5. Figure 3
Histology of vein injury associated with lead extraction (Movat pentachrome stains). A: A fibrous cuff is firmly attached to the wall of a vein. Note that the portion of the fibrous cuff adherent to the vein is very thin. The tissue at the edges of the section is stained darker as a result of thermal injury. A greater magnification of the boxed area is shown in B. A high-resolution version of the image is available as eSlide:VM B: A transmural segment of vein is present adjacent to the fibrous cuff. The tunica media contains circularly arranged layer of smooth muscle cells with the cytoplasm stained a light red or magenta. The tunica adventitia contains elastic fibers stained black interspersed with the collagen bundles stained yellow. The brown-black staining at the tissue edge is secondary to thermal injury. C: A segment of fibrous cuff has an attached partial thickness of vein wall. A higher magnification image of the boxed area is shown in D. D: The tunica media can be identified with a few smooth muscle cells and scattered elastic fibers. A distinct tunica adventitia is not identified as this specimen represents a gracing cut through the media/adventitia interface.
Heart Rhythm  , DOI: ( /j.hrthm )
Copyright © 2017 Heart Rhythm Society Terms and Conditions