INTRODUCTION
Cardiovascular Implantable Electronic Device (CIED) implantations have
increased over the past 2 decades because of expanded indications.
Following this increase there has been a parallel increase in the need
to extract CIED leads for infectious and non-infectious etiologies.
Nowadays, extractions of implanted leads are performed via transvenous
lead extraction (TLE) procedures usually through a superior approach via
the subclavian vein (SCV) 1 2.
Extraction tools can be categorized into mechanical non-powered sheaths
and powered sheaths. The latter can be divided into those that deploy a
source of energy in order to dissect encapsulating fibrous tissue (laser
and radiofrequency (RF) energy) and those that use handled triggered
rotational dissecting tip to achieve that goal. Overall, tool
development has made TLE a relatively safe and successful procedure3.
The once commonly used femoral approach, which compared to the superior
approach is associated with higher complication rates in the ELECTRa
prospective registry 1, has now become mainly a
bailout procedure in cases where superior TLE approach has failed and
thus familiarity with its use has decreased as well 24 . However, albeit the inferior’s approach reduced
application, each approach for TLE has its downgrades: While the femoral
approach may be associated with cardiac avulsions 5,
superior vena cava (SVC) tear remains a dreaded complication of the
superior approach 6. A combined superior and inferior
TLE approach has been suggested in order to gain the advantage of each
approach and avoid the caveats of the other 7.
Elaborating and refining predictors for femoral support or bailout
should help optimize the synergy between different approaches and
translate into an overall reduction in complications eventually
providing better procedural outcomes.
Previously, femoral TLE bailout was found to be associated with
prolonged lead dwell time and number of leads extracted in two
relatively large clinical cohorts, while infection as a predictor was
reported in one of these studies 8,9.
In the current study, we aimed to
determine the predictors and outcomes for TLE requiring a femoral
bailout, including those procedures performed in the presence of
occluded veins, compared to procedures performed solely by a superior
approach.