Transfemoral Snaring and Stabilization of Pacemaker and Defibrillator Leads to Maintain Vascular Access During Lead Extraction

Abstract

Our series demonstrates the simple and safe technique of transfemoral lead snaring to assist lead extraction and maintain vascular access in the setting of venous occlusion, when the distal lead tip pulls free of the myocardium before an extraction sheath is passed beyond the point of venous obstruction.

The challenges of transvenous lead extraction

“…Lead stabilisation by femoral snaring via an inferior approach provides a straighter ‘rail’ for the extraction approach from the right internal jugular vein, decreasing the likelihood of SVC avulsion. Recently, Fischer et al 15 described a hybrid superior and inferior approach, with femoral snaring of the lead to provide stability from below while counterpressure and traction were applied from above. They demonstrated this to be a safe and effective technique for lead extraction with maintenance of venous access.…”

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

“…The symptomatic form of this complication occurs in 0.35–3.5% of patients [3, 4], while asymptomatic blood flow limitation is found in up to 50% of patients [5]. The successful upgrade of the system may require different techniques [6–8]. One of them is lead extraction with the use of mixed subclavian and femoral access.…”

Strategies for Transvenous Lead Extraction Procedures

“…39 Lead stabilization by femoral snaring via an inferior approach provides a straighter ''rail'' for an extraction approach from the right internal jugular vein, decreasing the likelihood of SVC avulsion. Recently, Fischer et al 35 described a hybrid superior and inferior approach with femoral snaring of the lead to provide stability from below while counterpressure and traction were applied from above. The researchers demonstrated this to be a safe and effective technique for lead extraction while maintaining venous access.…”

“…This approach-which involves femoral snaring of the lead as a means to stabilize the lead while countertraction and counterpressure are used to free the leadreinforces the clinical importance of femoral retrieval. 35 Rescue tools. The performance of transvenous lead extraction has the potential for significant morbidity and mortality, and complications are inevitable.…”