Reuse of occluded veins during permanent pacemaker lead extraction: a new indication for femoral lead extraction.

Objectives: This study examined the utility of a novel technique for reuse of thrombosed veins when extracting permanent pacemaker leads via a femoral vein approach.

Background: Although lead extraction permanent pacemaker using a femoral approach has advantages over the subclavian approach, it cannot be used to provide access for a new lead using currently employed techniques. This is important because up to 23% of patients have occluded veins after permanent pacemaker implantation.

Methods: The pacemaker lead to be extracted was released from the generator and retaining sutures at the implantation site. The lead was then grabbed from below using a needle-eye-snare or basket. The lead was then cut short and a drag through technique performed where a guide wire was pushed into the gap between the insulation and the coil. This guide wire was then drawn into the right atrium as the lead was pulled down from below. This guide wire was then used to introduce a sheath through which a replacement lead could be inserted.

Results: A total of 34 consecutive patients (21 male, aged 63+/-14 years, mean+/-SD) had 57 (1.7/patient) leads extracted. Fourteen patients required implantation of a new system and were suitable for immediate lead replacement using the drag through technique. All leads were successfully extracted, with 5 partial successes (9.1% of leads). The drag-through technique was successful in all, including 4 with subclavian vein occlusion. Procedure and fluoroscopy times, including the time required for implantation of a new system, were 143+/-65 mins and 31+/-23 mins respectively. There were no complications and hospital stay was 1.6+/-1.2 days for patients undergoing the drag-through procedure.

Conclusion: The drag-through technique can be successfully used to provide access in order to replace pacemaker leads removed using a femoral approach.