At North Mountain, Dr. Seifert has a sophisticated laser system for removing pacemaker and defibrillator lead wires that have become “glued” inside veins by scar tissue that has grown around them. There are only a handful of such devices in the Valley and not every interventional cardiologist or electrophysiologist knows how to use one.

Dr. Seifert makes it sound simple – even though it’s far from it. “The device is a sleeve that fits around the wire, inside the vein,” he explained. “The leading edge of the sleeve is ringed with fiber-optics that conduct impulses from a laser that vaporizes scar tissue in its path. This clears a space around the wire so it can be extracted from the vein.”

After placing a temporary pacemaker wire through the veins in Inman’s leg, he surgically, he removed the device from the right side of her chest, and the painful leads under the skin of her chest. He then used the laser to help him extract the old pacemaker leads from Inman’s veins.

But as soon as the lead wires were extracted, the veins collapsed. The implant of a new device would require open veins in a different location, free of bacterial contamination, after several days of antibiotics. Even the leg veins were considered, a route almost never used for pacemakers and defibrillators due to multiple problems in this location.

“I’d love to take complete credit for healing Mrs. Inman,” Dr. Seifert said. “But the truth is that her problems were solved because of unique teamwork that is possible between specialists from different disciplines at John C. Lincoln Hospitals.”

Dr. Seifert called MDIG-Vascular & Interventional Physicians to open Inman’s blocked veins in the left chest area so he could properly install the wire leads connecting her defibrillator to her heart. MDIG’s physicians who responded included Gaurav Patel, MD, who did the initial consultation, and Aaron Wittenberg, MD, who performed the delicate procedure to open Inman’s veins.

Together, Dr. Wittenberg and Dr. Seifert provided complicated, sophisticated interventional care in a combined procedure that neither could provide alone. “You could say I built the highway and Dr. Seifert drove the high performance car,” Dr. Wittenberg quipped.

After verifying that all of Inman’s major veins between her head, neck, arms and heart were totally blocked with scar tissue, Dr. Wittenberg launched a multi-part procedure to create a space in which Dr. Seifert could work.

“I was able to run a really thin wire from the jugular vein in her neck through the subclavian and brachiocephalic veins to the superior vena cava, the main vein that leads into the heart,” Dr. Wittenberg said. “That wire guided a tiny balloon into the vein that I could inflate to expand it to maybe 3 mm.” That’s less than a tenth of an inch.

“Even though the space wasn’t very big,” Dr. Wittenberg continued, “it let me insert a stiffer wire with a balloon that expanded the vein to 5 mm in diameter. That let me continue with a series of gradually increasing bigger wires and balloons until I was able to expand the vein to a diameter of 12 mm.” That’s a little less than half an inch, but big enough to insert a defibrillator lead.

“However,” Dr. Wittenberg said, “the vein would collapse as soon as I withdrew the balloon, so I inserted a stent to hold the vein open.” The stent, a mesh metal tube, was 12 mm in diameter and 80 mm long – just over three inches.

Dr. Seifert had his highway. It was the clear path he needed to run the lead wire to Inman’s heart and hook up her defibrillator. With access to veins, there was no longer a need to implant the defibrillator wires under the skin on both sides of her chest, as had caused significant and chronic pain in the past, nor a need to consider leg veins.

Because Inman is slim with little fat or tissue between her skin and the chest muscles, Dr. Seifert carefully divided the muscle fibers to slip the defibrillator beneath the chest muscle, resulting in almost no discomfort or visible protrusion. The muscle provides excellent padding for the device implanted beneath, making future erosion of the device through the skin almost impossible.

Five weeks after the procedure, Inman said she was still healing, but the chronic pain was almost gone. “I’m trying to get my energy back,” she said.

“This is the first Christmas I’ve actually gone out shopping – I went out one day and bought Barbies for my great grandchildren,” she said. “It’s a slow recovery, but each day really is better than the day before. Finally, I have hope.”