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

BACKGROUND: Lead extraction is an effective method for removing pacemaker and defibrillator leads and to obtain venous access when central veins are occluded. OBJECTIVE: We report a series of patients who required lead extraction and preservation of vascular access requiring a vascular snare introduced from the femoral vein to provide traction on the lead. This technique allowed advancement of the extraction sheath beyond the level of vascular occlusion, preserving vascular access in all patients. METHODS: All patients had peripheral contrast venography performed immediately prior to the procedure to identify the site(s) of venous occlusion. An extraction sheath was employed and with direct manual traction, the lead tip pulled free from the myocardial surface prior to advancement of the sheath beyond the occlusion. A transfemoral snare was used to grasp the distal portion of the lead and traction was used to immobilize the lead. RESULTS: In all patients, transfemoral snaring of the leads was necessary to allow safe advancement of a sheath to open the occluded venous system. There were no complications in any of the patients. CONCLUSION: 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.