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.