Lead extraction using the femoral vein

      Lead extraction using the femoral vein is an alternate approach for lead removal. It has often been dubbed “the inferior approach.” This is because today it is often reserved for use only after a failed primary approach via the implant vein. In reality it is the most versatile approach for lead removal. Prior to the advent of powered sheaths, it was frequently used as a primary approach. It is also the only approach, and the procedure of choice, for removal of broken or cut leads with free ends. These leads and lead parts are usually free-floating in the venous system, heart, or pulmonary arteries. Historically, lead retrieval techniques have evolved from interventional radiology as it became necessary to retrieve or snare catheters, wires, and other spare parts lost in the central circulation. These techniques date back to the 1960s.
      • Massumi R.A.
      • Ross A.N.
      Atraumatic nonsurgical technique for removal of broken catheters from the cardiac cavities.
      Today, a number of tools and techniques have been developed for extracting leads by the femoral vein (Table 1, Table 2).
      Table 1Techniques of femoral lead extraction
      I Pigtail Catheter, and Dotter Snare
      II Wire Loop Snare
      III Amplatz Snare (Microvena Corp)
      IV Byrd Femoral Work Station, Deflecting wire and Dotter Snare (Cook Vascular Inc)
      V Byrd Femoral Work Station, Deflecting wire (Cook Vascular Inc), and Amplatz Snare (Microvena Corp)
      VI Byrd Femoral Work Station and Needle’s Eye (Cook Vascular Inc)
      Table 2Tools for femoral lead extraction
      I Byrd Femoral Work Station (Cook Vascular Inc., Leechburg, PA)
      • a
        16 French Outer Sheath with check Valve
      • b
        Inner Sheath
      • c
        Deflecting Wire
      • d
        Deflecting Handle
      II Dotter retriever Snare
      III Curry Loop Snare
      IV Amplatz Snares 25 mm, 35 mm (Microvena Corp)
      V The Needles Eye Snare (Cook Vascular Corp)


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