Bidirectional Retrieval of a Fractured Femoral Venous Sheath

OBJECTIVE: To describe a step-by-step bailout technique for percutaneous retrieval of a fractured femoral venous sheath during redo atrial fibrillation ablation. KEY STEPS: 1) Promptly recognize sheath hub-body separation and preserve the original J-shape guidewire within the retained sheath lumen; 2) confirm fragment location in the femoral vein by contrast venography through a second ipsilateral 8-F sheath in the right anterior oblique 20° view; 3) advance an SeQure LT-SP snare through the second sheath to capture and externalize the distal guidewire; 4) apply gentle simultaneous traction from both externalized wire ends to align the fragment with the original venous tract and remove it safely. POTENTIAL PITFALLS: Blind pulling before confirming fragment position may increase the risk of central embolization. This technique may be unsuitable if no guidewire remains within the retained fragment lumen, if the fragment embolizes centrally, or if major venous injury is suspected. TAKE-HOME MESSAGES: Preservation of the original intraluminal guidewire is the key prerequisite for this bailout strategy. Snare-assisted guidewire externalization with controlled bidirectional traction may allow safe percutaneous retrieval and avoid surgical cutdown.