INTRODUCTION: Transvenous Lead Extraction (TLE) is usually
performed via a superior approach. Predictors and outcomes of TLE
requiring femoral vein bailout are poorly defined. We aimed to analyze
predictors and consequences of TLE requiring femoral bailout.
METHODS: A single tertiary center cohort of 421 consecutive
patients who underwent TLE between May 2010 and February 2020 were
analyzed. Venography was routinely performed before system upgrade to
identify occluded veins. Patients were divided into 2 groups according
to their need for femoral bailout extraction. RESULTS: A total
of 928 leads were extracted with femoral bailout approach was needed in
71 leads(7.7%) among 49 patients(11.6%). A higher proportion of right
ventricular(RV) leads required femoral bailout approach compared with
right atrial(RA) leads[51/499(10.2%) vs 18/326(5.5%);p=0.02].
Femoral bailout was more common among younger patients, longer lead
dwell time, more pocket entries, higher number of extracted leads,
presence of abandoned leads and among patients with vascular occlusion.
Following multivariate analysis, presence of abandoned leads, vascular
occlusion and younger age remained a significant predictor for femoral
bailout. Femoral bailout resulted in higher rates of major complications
[5/49(10.2%) vs 12/372(3.2%);p=0.05] without intra-procedural
mortality and no additional 30-day mortality[2/49(4.1%) vs
33/377(8.8%);p=0.39]. CONCLUSION: TLE of abandoned leads,
occluded veins and younger age were found to be predictors of femoral
bailout requirement. Despite higher rates of major complications in
femoral TLE bailout, mortality was not increased. Venography prior to
TLE should be considered for procedure planning.