Intravascular lead extraction using the excimer laser: pitfalls and tips for success

Removal of retained pacemaker and defibrillator leads is often indicated in the face of infection, venous obstruction, or lead malfunction with the need to upgrade to a newer lead. While simple traction is often successful in newly placed or infected leads, chronic leads can be problematic in their removal. The laser extraction sheath offers a method for removal by "cutting" through scar tissue. This device can be potentially hazardous, so the laser lead extraction procedures should be performed in a properly equipped operating room for immediate cardiothoracic surgical intervention should massive bleeding occur. This article outlines a few suggestions for avoiding severe complications with this useful procedure.