title: Transfemoral access when superior venous approach is not feasible equals overall success of permanent pacemaker implantation. Ten-year series.
abstract: BACKGROUND
  When permanent pacemaker implantation is not possible or advisable via superior venous access (i.e., axillary or subclavian veins), safe and feasible surgical alternatives are required. The femoral approach is relatively unknown and seldom studied. This single-center study analyzed 10-year outcomes of a femoral implantation approach.
  
  
  METHODS
  Data about the implantation procedure (indication, approach, lead and pacemaker models, complications), patient characteristics (age, sex, medications, comorbidities), and follow-up were analyzed for all permanent pacemaker implantations using the femoral approach between June 2001 and June 2011.
  
  
  RESULTS
  A permanent pacemaker was implanted with the femoral approach in 50 patients (mean age, 76 years [range: 45-96], 31 [61%] men). The most frequent indication was atrioventricular block, associated with sinus rhythm in 30 patients and with atrial fibrillation in eight patients. Overall, 20 patients (40%) were treated with oral anticoagulants postimplantation. Mean implantation time was 64 minutes (range: 20-210) and mean fluoroscopy time was 6.7 minutes (range: 0.2-50). Minimum follow-up window was 1 year (June 2012), with a mean of 50 months [range: 1-113]). No deaths, septic episodes, or severe complications were associated with the procedure, acute or long-term. Follow-up data were available for 46 patients, of who 21 (46%) died during follow-up (mean age, 87 years [range: 73-101]). No cause of death was associated with the femoral technique.
  
  
  CONCLUSIONS
  Permanent pacemaker implantation through femoral access is not difficult for an experienced implant surgeon. Outcomes were comparable to systems implanted by superior venous approach, and no severe complications were observed at 10-year follow-up.
authors.affiliation: Department of Cardiology, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Juan J
authors.identifier: http://orcid.org/0000-0001-7548-4108
authors.initials: JJ
authors.lastname: García Guerrero
authors.affiliation: Department of Cardiology, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Fernández de la Concha Castañeda
authors.affiliation: Department of Cardiology, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Doblado Calatrava
authors.affiliation: Department of Cardiology, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Redondo Méndez
authors.affiliation: Department of Cardiology, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Lázaro Medrano
authors.affiliation: Department of Cardiology, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Merchán Herrera
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000706:statistics & numerical data; D015984:Causality; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D019919:Prosthesis Implantation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013350:Subclavian Vein / Q000601:surgery; D016896:Treatment Outcome
keywords: femoral approach; iliac; permanent pacemakers; transfemoral; venous occlusion