title: Extraction of old pacemaker or cardioverter-defibrillator leads by laser sheath versus femoral approach.
abstract: BACKGROUND
  Some operators routinely extract chronically implanted transvenous leads from a femoral, whereas others prefer a superior approach. This prospective study compared the safety and effectiveness of laser sheaths versus femoral snare extractions.
  
  
  RESULTS
  The single-center study comprised 101 patients referred for unequivocal indications to extract > or =1 transvenous lead(s). Patients were >4 years of age and were randomly assigned to extractions with a laser sheath (group 1: n=50) versus a snare via femoral approach (group 2: n=51). The multicenter study comprised 358 patients who underwent extraction of old transvenous leads using laser sheaths (n=218, group 3) in 3 centers and from a femoral approach (n=138, group 4) in 3 other centers. In the single-center study, the success and complications rates were similar in groups 1 and 2. No patient died of a periprocedural complication. The procedural duration (51+/-22 versus 86+/-51 minutes) and duration of total fluoroscopic exposure (7+/-7 versus 21+/-17 minutes) were significantly shorter (each P<0.01) in group I than in group 2. In the multicenter study, we observed 2 procedure-associated deaths in group 3 versus 1 in group 4. Major procedural complications were observed in 3% of patients in group 3, versus 3% in group 4 (P=NS). The rates of complete, partial, and unsuccessful extractions were similar in groups 3 and 4.
  
  
  CONCLUSIONS
  Old transvenous leads were extracted with similar success and complication rates by the femoral and laser approaches. However, the femoral approach was associated with longer procedures and a longer duration of fluoroscopic exposure.
authors.affiliation: Hospital Du Haut-Leveque, Service Pr Clementy, Pessac, France. bordacharp@hotmail.com
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.forename: Eric
authors.initials: E
authors.lastname: Peyrouse
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.forename: Bilel
authors.initials: B
authors.lastname: Mokrani
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.forename: Laurent
authors.initials: L
authors.lastname: Barandon
authors.forename: Emilie Marcant
authors.initials: EM
authors.lastname: Fossaert
authors.forename: Stephane
authors.initials: S
authors.lastname: Garrigue
authors.forename: Sylvain
authors.initials: S
authors.lastname: Reuter
authors.forename: Julien
authors.initials: J
authors.lastname: Laborderie
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.forename: Peggy
authors.initials: P
authors.lastname: Jacon
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.forename: Antoine
authors.initials: A
authors.lastname: Deplagne
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.forename: Jacques
authors.initials: J
authors.lastname: Clementy
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005471:Fluoroscopy; D005602:France; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D011829:Radiation Dosage; D015641:Radiography, Interventional; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome