Successful avoidance of superior vena cava injury during transvenous lead extraction using a tandem femoral-superior approach

BACKGROUND Transvenous pacemaker and defibrillator lead extraction is a higher risk procedure with variation in preferred technique. A frequently fatal complication of this procedure is perforation of the superior vena cava. We have developed a tandem femoral-superior technique that incorporates snaring of targeted leads from a femoral approach combined with use of a rotational cutting sheath advanced over the lead from the subclavian vein. OBJECTIVE We sought to evaluate the safety and efficacy of a tandem femoral-superior approach to lead extraction. METHODS Consecutive patients undergoing transvenous extraction of at least 1 pacemaker or defibrillator lead with implant duration >= 1 year in which a tandem femoral-superior technique was used as the initial extraction strategy were included. The registry spanned 2010-2018 and consisted of procedures performed by a single primary operator. RESULTS A total of 131 patients were included. A total of 267 leads with a mean implant duration of 9.8 years, including 90 defibrillator leads (33.7%), were targeted for extraction. No superior vena cava perforation or other vascular damage occurred. Clinical procedural success was achieved in 96.2% of cases. There were 5 major complications (3.8% of patients), with 3 being pericardial effusion requiring intervention. There were no deaths. CONCLUSION A tandem femoral-superior approach to lead extraction effectively eliminated superior vena cava injury. This is a safe and effective technique for transvenous lead extraction.