Percutaneous lead extraction by femoral approach, case report

Transvenous lead extraction is usually done via subclavian route, here we present an extraction case performed by femoral approach. 72 year old patient who has a VVI pacemaker with one passive fixation and one active fixation lead admitted to our clinic with pacemaker decubitus. We decided to remove all hardwares and insert a new battery and lead on contralateral side. However the first passive lead was deep inside the subclavian region so we planned to use femoral approach for lead extraction if subclavian approach fails in the patient. In the catheterization laboratory active fixation lead is easily explanted by simple traction but the passive lead could not be reached by subclavian approach. We decided to use the femoral Byrd Workstation 12 F™ and Needle's eye Snare® to extract lead femorally. The lead is snared at subclavian end and is extracted by applying gentle simple traction and taken into the femoral Byrd Workstation 12 F™. We implanted new pacemaker at contralateral side and discharged patient uneventfully. Percutaneous femoral approach for lead extraction is generally used as bail-out procedure for leads that cannot be extracted by subclavian approach but as in our case it can be used primarily according to the clinical presentation of the patient.