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).