One step behind to step ahead – femoral approach to stabilize and to extract functional pacing lead to regain venous access

Abstract

Transvenous lead extraction can be a method to regain venous access. We present the case of a man, aged 67, with indications to upgrade an ICD to a resynchronization therapy device. Since innominate vein occlusion was diagnosed and extraction of an abandoned ventricular pacing lead did not provide lumen regain, a functional atrial lead was extracted with the femoral approach to stabilization and venous access was regained. Asymptomatic vein wall damage but no other complications were recorded. The simultaneous application of different techniques to regain venous access may allow success of the final procedure in system upgrading.

Lead extraction: The road to successful cardiac resynchronization therapy

“…In 1 case described previously it was indispensable to use more advanced techniques to regain the venous system access [3]. In one of the patients, the adhesions between the lead and the vascular system were too weak to overcome the occlusion in the innominate vein with telescoping sheaths because the moderate traction caused complete removal of the lead before the sheath reached the other side of the occlusion.…”

“…Venous access retrieval, sometimes with the loss of the working lead, enables successful implantation. Often the countertraction from femoral approach as well as long, measuring over 20 cm, peel-away introducers have to be used in such procedures [3,25,26].…”