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Transvenous Lead Extraction: The Femoral Pull-Through Technique
Zaki Akhtar1, Manav Sohal1, Raymond H Schaerf2
1Department of Cardiology, St. George's University Hospital NHS Foundation Trust, London, UK.
Background:
Transvenous lead extraction (TLE) plays a significant role in maintaining device therapy. Conventional extraction involves advancing an extraction sheath via the implanting vein over the targeted lead, however advanced techniques involve the use of the jugular and femoral accesses which provide geometrical advantages. Femoral extraction can be used as a "bail-out" and a primary extraction strategy but with significant challenges.
Method:
We present a novel technique, transferring a 20-year-old passive fixation atrial lead with a deployed locking stylet from the subclavian vein to the femoral site, to complete the extraction of an infected system.
Result:
Transfer of the lead from the implanting vein to the femoral vein, permitted linear alignment of the femoral sheath to the passive fixation atrial lead, safely enhancing the application of traction and counter-traction. The lead was extracted without sequalae.
Conclusion:
The femoral pull-through technique is safe and effective, with potential application in a range of scenarios.
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