Update on indications, techniques, and complications of cardiac implantable device lead extraction

All devices (quite simply and with rare exception) that are infected, or strongly suspected of being infected, need to be removed, with complete extraction of all intravascular hardware and foreign material in the pocket. Failure to do so nearly always results in a failure to clear the infection, with inevitable recurrence of infection. Having the skills and tools to extract leads can make access to the venous system possible when occlusion or stenosis is present, thus preserving the venous system on the contralateral side. The far more controversial question is how one should deal with leads that are functional and are no longer needed, as well as leads that are non-functional and not connected to a device. Patients who are expected to outlive their next device, or who are potential candidates for MRI scans in the future, should be considered for extraction of all unused lead hardware. Doing so at an earlier time prevents the need to extract when the leads are older and more difficult to remove, and eliminates the additional risk of infection by preventing an additional procedure on the device pocket at a later date.