title: Impact of a femoral snare approach as a bailout procedure on success rates in lead extractions.
abstract: OBJECTIVE
  In cases of challenging transvenous lead extraction procedures, limitations exist for the subclavian approach (SCA). In case of absent alternative approaches, the procedure may end with failure. Therefore, we investigated the femoral snare approach (FSA) as bailout procedure.
  
  
  METHODS
  From December 2010 to August 2013, 114 patients with 190 leads were scheduled for transvenous lead extraction procedures [mean implant duration (MID): 74.7 (1-384) months]. In 28 leads [MID: 133.8 (36-384) months] the FSA was used. In 20 leads [MID: 127.5 (52-258) months] the FSA was performed as bailout approach and in 8 leads [MID: 149.6 (36-384) months] as first-line approach due to complete intravascular lead position.
  
  
  RESULTS
  In all FSA procedures (n = 28), clinical success was 85.7% and complete procedural success 64.3%. In FSA procedures as bailout approach (n = 20), clinical success was 80.0% and complete procedural success 55.0%. In first-line FSA procedures (n = 8), clinical success was 100.0% and complete procedural success 87.5%. Overall (n = 190) clinical success was 96.3%, complete procedural success 91.1%. By adding the FSA in cases of insufficient or impossible SCA, clinical success was increased by 12.6% (from 83.7 to 96.3%) and complete procedural success by 9.5% (from 81.6 to 91.1%). Comparison of leads extracted by SCA with leads extracted by FSA revealed that MID [133.8 (36-384) vs 64.4 (1-300) months; P < 0.0001] and the rate of passive fixation leads (67.9 vs 28.4%; P < 0.0001) were significantly higher in the FSA group.
  
  
  CONCLUSIONS
  In cases of failed or impossible subclavian approach, the femoral snare approach may improve overall success rates without relevantly increasing operative risk.
authors.affiliation: Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christoph Thomas
authors.initials: CT
authors.lastname: Starck
authors.forename: Etem
authors.initials: E
authors.lastname: Caliskan
authors.forename: Holger
authors.initials: H
authors.lastname: Klein
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Femoral snare extraction; Lead extraction; Pacemaker; implantable cardioverter defibrillator