The benefits of routine prophylactic femoral access during transvenous lead extraction

Background The number of patients with necessity for lead extraction has been rising in recent years. Despite significant advances in operator experience and technique, unexpected complications may occur. The prophylactic placement of femoral sheaths allows for immediate endovascular access for emergency procedures and may shorten response time in face of complications. Objectives The aim of this study was to assess the benefits of routine prophylactic femoral access in patients undergoing TLE and to evaluate methods, frequency and efficacy of the deployed emergency measures in those patients. Methods We conducted a retrospective analysis of patients who underwent TLE from January 2012 until February 2019. The data was analyzed in regards to procedural complications and deployment of emergency measures via femoral access. Results 285 patients with a mean age of 65.3±15.5 years were included. Median lead dwell time was 84 [IQR: 58 – 144] months. Overall complication rate was 4.2% (n=12) with 1.8% major complications (n=5). Clinical success rate was 97.2%. Procedure-related mortality was 1.1% (n=3). Femoral sheaths were actively engaged in 9.1% (n=26) of cases, with deployment of snares being the most common intervention (n=10), followed by prophylactic- (n=6) or emergent placement (n=1) of occlusion balloons, temporary pacing (n=3), venous angioplasty (n=3), diagnostic venography (n=3) or implantation of an ECMO (n=1). We did not observe any femoral vascular complications due to prophylactic sheath placement. Conclusion The routine prophylactic placement of femoral sheaths enables to shorten response time and quickly establish control in face of various complications that may be encountered during TLE procedures.