title: Predictors and outcomes of lead extraction requiring a bailout femoral approach: Data from 2 high-volume centers.
abstract: Lead extraction (LE) infrequently requires the use of the "bailout" femoral approach. Predictors and outcomes of femoral extraction are not well characterized.
  
  
  
  The aim of this study was to determine the predictors of need for femoral LE and its outcomes.
  
  
  
  Consecutive patients who underwent LE at our centers were identified. Baseline demographic characteristics, procedural outcomes, and clinical outcomes were ascertained by medical record review. Patients were stratified into 2 groups on the basis of the need for femoral extraction.
  
  
  
  A total of 1080 patients underwent LE, of whom 50 (4.63%) required femoral extraction. Patients requiring femoral extraction were more likely to have leads with longer dwell time (9.5 ± 6.0 years vs 5.7 ± 4.3 years; P < .001), to have more leads extracted per procedure (2.0 ± 1.0 vs 1.7 ± 0.9; P = .003), and to have infection as an indication for extraction (72% vs 37.2%; P < .001). Procedural and clinical success was lower in the femoral extraction group than in the nonfemoral group (58% and 76% vs 94.7% and 97.9 %, respectively; P < .001). Major periprocedural complications (0% vs 1.3%; P = 1.0) and periprocedural mortality (0% vs 0.8%; P = 1.0) were similar between the 2 groups.
  
  
  
  In this study, femoral extraction was needed in ~5% of LEs. Longer lead dwell time, higher number of leads extracted per procedure, and the presence of infection predicted the need for femoral extraction. Procedural success of femoral extraction was low, highlighting the fact that this approach is mostly used as a bailout strategy and thus selects for more challenging cases.
authors.affiliation: Department of Medicine-Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: melcham@emory.edu.
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
authors.affiliation: Department of Medicine-Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Merchant
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Anam
authors.initials: A
authors.lastname: Waheed
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Furqan
authors.initials: F
authors.lastname: Khattak
authors.affiliation: Georgia State University, Atlanta, Georgia.
authors.forename: Jad
authors.initials: J
authors.lastname: El-Khalil
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Patel
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Sayegh
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Yaanik
authors.initials: Y
authors.lastname: Desai
authors.affiliation: Department of Medicine-Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Angel R
authors.initials: AR
authors.lastname: Leon
authors.affiliation: Department of Medicine-Division of Cardiology-Section of Electrophysiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
mesh_terms: D000367:Age Factors; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D002406:Catheterization, Peripheral / Q000379:methods*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000706:statistics & numerical data; D020878:Device Removal / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D004868:Equipment Failure; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Device infection; Femoral extraction; Lead extraction; Lead failure; Outcomes