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.
1
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) |
|
| 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) |
Keywords
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References
- Atraumatic nonsurgical technique for removal of broken catheters from the cardiac cavities.N Engl J Med. 1967; 277: 195
- The Dotter retriever and pigtail catheter: efficiency in extraction of chronic transvenous pacemaker leads.PACE. 1993; 16: 2337
- Recovery of a detached intravascular catheter or guidewire fragments: a proposed method.Am J Radiol. 1969; 105: 894
- Lead extraction: indications and techniques.Cardiol Clin. 1992; 10: 735-748
- Transluminal extraction of catheter and guide fragments from the heart and great vessels: twenty-nine collected cases.Am J Radiol. 1971; 111: 467
- The Nitinol “Gooseneck” snare for foreign body removal: an experimental study and clinical evaluation.Am J Radiol. 1991; 156: 1007
- Extraction Using the Femoral Vein.in: Belott P.H. Endocardial Lead Extraction: A videotape and manual. Futura Publishing, Armonk NY1998: 69-92
Article info
Publication history
Published online: June 18, 2007
Identification
Copyright
© 2007 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
