Cosmetic aspects of device implantationThe cosmetic aspects of device implantation imply achieving an aesthetically pleasing surgical result. It involves concealing the cardiac implantable electronic device, avoiding unsightly scars, device bulges, and protrusion (Figure 1). Cosmetic device implantation is indicated for the extremely thin patient at risk of erosion and the young patient concerned with body image. These techniques are also important in the pediatric population, patients with burn injury, and patients after mastectomy.
Lead extraction using the femoral veinLead 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.