Transvenous Lead Extraction Using a Stepwise Bailout Strategy: A Single-Center Experience with Wrap-Around Rescue in Selected Bailout Cases

Background/Objectives: Femoral techniques can rescue transvenous lead extraction (TLE) when the superior approach is insufficient, but wrap-around rescue within a stepwise pathway remains incompletely characterized. We described a single-center cohort and examined the association between target-lead dwell time and bailout use. Methods: Among 82 retrievable TLE records from 2014 to 2025, four image-only records lacked the clinical, procedural, and follow-up information required for analysis; 78 patients were included. Bailout comprised femoral gooseneck snaring and/or RF Marinr catheter wrap-around. Results: Complete procedural success was 77/78 (98.7%), lead-level complete removal 155/156 (99.4%), clinical procedural success 78/78 (100.0%), bailout complete removal 18/19 (94.7%), and wrap-around complete removal 16/17 (94.1%). Median extraction-phase and total skin-to-skin durations were 79.7 and 110.1 min, respectively; median extraction fluoroscopy time was 21.8 min and system-reported air kerma 324.5 mGy. Bailout procedures had longer fluoroscopy than primary-only procedures (31.4 vs. 16.6 min; exploratory p = 0.011), whereas extraction-phase duration and air kerma did not differ significantly. Formal major and minor complications were 0/78 through day 30; four minimal subcutaneous hematomas required observation only. In an exploratory Firth model, dwell time remained associated with bailout (adjusted OR/year, 1.14; 95% CI, 1.05–1.25; p < 0.001). Conclusions: Wrap-around was used within a successfully selected bailout pathway, but its independent effect cannot be isolated. Resource and association analyses are exploratory and noncausal.