A triple access transvenous approach can facilitate the extraction of challenging, chronically implanted pacemaker leads when standard approaches fail.
May aid extraction of old leads after standard failure; leaves open need for prospective validation.
A 39-years old ventricular lead of a right-sided single-chamber pacemaker required extraction for infection. Angulation at the right subclavian-superior vena cava junction coupled with calcified fibrotic encapsulating tissue prevented advancement of a rotational dissecting sheath. To straighten the lead, it was pulled from the subclavian and out of the right internal jugular vein, whilst the Needle's-Eye Snare via the femoral access provided counter-traction. A 13-french rotational dissecting sheath was successfully advanced over the lead via the jugular access to complete the lead extraction without any complication.
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Akhtar et al. (2022) studied this question.
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