BASELINE CHARACTERISTICS AND PREDICTORS OF FEMORAL BAILOUT
A total of 421 patients underwent extraction from May 2010 to February 2020. 49 patients(11.6%) required a femoral bailout approach. Of the total 928 lead extracted, 71(7.7%) needed a femoral bailout following a failed superior approach attempt.
Patients in the femoral bailout group were younger(age 58±19 vs 67±15;p<0.01) and had less vascular disease(37% vs 58%;p=0.04)(Table 1). The two groups were comparable in all other comorbidities. Patients requiring femoral bailout had an increased number of extracted leads(3[2,3] vs 2[1,3]), longer lead dwell time (years from first lead implantation to extraction)(9.5[5.05, 13.94] vs 5.62[2.52, 8.94], had at least one abandoned lead present (53% vs 15%;p<0.01) and experienced more previous entries into pocket(71% vs 49%;p=0.01).
For both approaches, the most common indication for TLE was CIED infection(71% vs 79%, p=0.3). Occluded veins found during routine venography before system upgrade were the second most common indication for the femoral bailout group, whereas this indication was less prevalent among TLE achieved by a superior approach[8/49(16%) vs 5/372(1%);p<0.01]. Vascular occlusion was overall identified in 34 patients by the following division: 13 by routine venography before system upgrade; case by case decision to perform venography before non-infectious procedures in 9 patients; known SVC syndrome or occluded veins as the driving reason for TLE in 7 patients; and finally in 5 patients occluded veins was identified on day of operation. Extraction in the presence of occluded veins via superior approach without femoral bailout was achieved in only 19 out of 34 procedures(56%).
Patients older than 60 comprised a large proportion[294/421 (69.8%)] of our cohort, and infectious TLE etiologies[251/294, (85.4%)] were the primary causes for extraction in this population. Femoral bailout rates due to infectious etiologies varied significantly between older and younger patients, as an exceptionally low percentage of femoral supports were required for elderly patients in comparison to younger patients[16/251 (6.4%) vs 19/78 (24.4%) respectively;p<0.01]. Conversion rates for femoral bailout due to non-infectious reasons were similar between older and younger patients[7/43 (16.3%) vs 7/49 (14%);p=0.79]. Finally, the younger TLE patients (age<60) had longer lead dwelling time in comparison to older patients[7.31 (3.8-11) vs 5.32 (2.42-9.17);p=0.002].
Multivariable analysis revealed that older age was associated with a lower rate of femoral bailout[0.97 (95% CI 0.95-0.98);p=0.009], presence of an abandoned lead[4.99 (95% CI 1.48-10.95);p=0.006] and vascular occlusion[7.88 (95% CI 3.21-20.1);p<0.01] remained significant predictors for need of femoral bailout, while other baseline parameters did not(Table 2).