The SAIL Technique: Snare-Assisted Intravascular Lead-to-Wire Conversion for Venous Access Preservation During Transvenous Lead Extraction in Venous Occlusion

Figures

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  Figure 1. Step-by-step fluoroscopic images of the intravascular phase of the Snare-Assisted Intravascular Lead-to-Wire Conversion technique. A: Preprocedural venography demonstrating occlusion of the left subclavian vein. B: Baseline fluoroscopic image showing the pre-existing atrial and ventricular leads at the start of the procedure. C: After extraction of the atrial lead, adhesion dissection of the ventricular lead was performed using a laser sheath. D: The ventricular lead tip was detached from the myocardium, but surrounding fibrotic tissue prevented complete accommodation of the lead–tissue complex within the extraction sheath. E: The detached ventricular lead was grasped using an Osypka Snare catheter introduced from the femoral vein. F: The lead–snare system was pulled toward the left subclavian region to prepare for extracorporeal lead-to-wire conversion. Blue arrowheads indicate the Osypka Snare catheter, and yellow arrowheads indicate the ventricular lead.

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  Figure 2. Step-by-step extracorporeal lead-to-wire conversion in the Snare-Assisted Intravascular Lead-to-Wire Conversion technique. A: The detached ventricular lead grasped by the femoral snare was pulled toward the left prepectoral pocket. B: The lead–snare system was externalized through the pocket side while maintaining control of the intravascular route. C: After extraction of the atrial lead, further adhesion dissection of the ventricular lead was performed using a 9-F TightRail mechanical sheath. D: The distal end of the snare catheter was prepared for cutting at the pocket side. E: The distal end of the snare catheter was cut to open the catheter lumen. F: A guidewire was advanced through the lumen of the snare catheter from the femoral side. G: The guidewire was externalized from the pocket side through the snare catheter. H: After removal of the snare catheter, the guidewire remained in place, preserving venous access for subsequent lead implantation. Blue arrowheads indicate the Osypka Snare catheter, yellow arrowheads indicate the lead, and yellow arrows indicate the guidewire.