Percutaneous lead extraction for patients with large vegetations using an unusual technique

Key Teaching Points•Transvenous lead extraction in patients with large vegetations measuring greater than 2.5 cm should be done with care. We report successful transvenous lead extraction in 2 patients with large vegetations.•In the first case, large vegetations were adherent to the right atrium wall and tricuspid valve, but not the implantable cardioverter-defibrillator (ICD) leads. Then, the ICD leads could be extracted using a snare from the femoral vein.•In second case, large vegetations were tightly adherent to the right ventricular lead. Although the right ventricular lead and vegetation were smoothly pulled through the inferior vena cava, the vegetation was trapped at the right femoral vein. The vegetations were successfully removed by a percutaneous transluminal angioplasty balloon and a Fogarty catheter.•We describe removal of leads associated with large vegetations using novel techniques. •Transvenous lead extraction in patients with large vegetations measuring greater than 2.5 cm should be done with care. We report successful transvenous lead extraction in 2 patients with large vegetations.•In the first case, large vegetations were adherent to the right atrium wall and tricuspid valve, but not the implantable cardioverter-defibrillator (ICD) leads. Then, the ICD leads could be extracted using a snare from the femoral vein.•In second case, large vegetations were tightly adherent to the right ventricular lead. Although the right ventricular lead and vegetation were smoothly pulled through the inferior vena cava, the vegetation was trapped at the right femoral vein. The vegetations were successfully removed by a percutaneous transluminal angioplasty balloon and a Fogarty catheter.•We describe removal of leads associated with large vegetations using novel techniques.