PROCEDURAL OUTCOMES
Clinical and radiological success between approach groups was not
compared as femoral bailout group represents extraction failure of
superior approach methods. Only 7 patients who hadn’t suffered major
complication or death[7/421 (1.7%)] had superior approach
clinical\radiological failure without a femoral attempt.
A total of 928 leads were extracted in our cohort with 71 via a femoral
position. The operator decision to switchover to femoral bailout
intra-procedurally was carried out when the superior approach was not
fully successful for the following reasons: 37 of the 71 leads were
extracted via femoral bailout because of lead breakage(unrelated to
known vascular obstruction) occurring during the procedure itself. 19
leads were extracted via a femoral bailout because of vascular occlusion
causing either inability to pass and deploy tools or lead breakage.
Finally, in 15 leads femoral bailout was deployed due to inability to
extract the lead from the superior approach without causing lead
breakage.
RV leads comprised most[499/928 (53.8%)] of leads extracted(Figure
1). A higher proportion of RV leads had to be extracted from a femoral
approach compared with RA leads[51/499(10.2%) vs
18/326(5.5%);p=0.02]. A small fraction of left ventricular(LV) leads
[2/103(1.9%)] were extracted via the femoral access.
Abandoned leads comprised roughly 10 percent [91/928 (9.8%)] of the
extracted leads in our cohort. One third [30/91 (33%)] of them were
extracted transfemorally. The overall clinical success rates of
transfemoral abandoned leads extraction were much lower than
non-abandoned leads[22/30(73.3%) vs
40/41(97.6%);p<0.01].
Femoral bailout had a higher overall[18/18 (100%)] clinical success
of RA leads compared to RV leads[43/51(84.3% )](Figure 2).
The 2 LV leads requiring femoral bailout were extracted successfully.
Clinical[18/25(72%)] and radiological[11/25 (44%)] success
rates of femoral bailout extraction of RV abandoned leads was
exceptionally low.
All leads which were extracted via femoral approach due to vascular
occlusion had full radiological success[19/19(100%)], while only
roughly half of patients with femoral bailout due to lead breakage that
occurred during the procedure achieved radiological
success[19/37(51.3%)](figure 3).