Percutaneous lead extraction with mechanical sheaths in cardiac implantable electronic device infections

The treatment of choice for infections of cardiac pacing devices is currently percutaneous endovascular traction with mechanical or laser dissection sheaths, which in experienced hands has a success rate of almost 98% and a mortality rate of less than 1%.The success of the procedure depends mainly on the experience of the operator and the characteristics of the device itself (pacemaker/defibrillator, side and time of implantation, type, number and condition of the electrodes). Safe extraction with mechanical sheaths requires knowledge of the tools used in the procedure, a systematic approach (including all possible precautions), and a good understanding of the possible complications that may arise. It is also necessary to have the means available for early diagnosis and treatment.Throughout this review we will answer many questions: What to do before we start? How do we perform the extraction? Why use mechanical sheaths and what are their advantages over laser sheaths? Where to start and how to finish? (c) 2022 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cirugia Cardiovascular y Endovascular.