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Replacement of extracted permanent pacemaker or defibrillator leads by cannulation of veins using the femoral “drag through” technique
  1. R J Schilling
  1. Correspondence to:
    Dr Richard Schilling, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK;

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The development of specialised equipment has allowed permanent pacemaker lead extraction using minimally invasive techniques,1, 2 but despite this the major complication rate is approximately 1–3%.1, 2 One reason for this is that the fragile subclavian vein, superior vena cava, and right atrium may tear during the process of cutting away the fibrous tissue that enfolds the leads in these regions. Drawing the body of the lead, which has the narrowest profile (cf. the tip and electrodes), through this fibrous sleeve from below, using a femoral approach, avoids the need for this dissection. Furthermore, the dissection required when using a superior approach to expose the subclavian vein can be painful and time consuming. When using a femoral approach only superficial dissection to free the leads and remove the suture sleeves is required and therefore the procedure can be performed under local anaesthetic. The major disadvantage of the femoral approach is that it does not provide access for a replacement lead. This study investigated the feasibility of a modification to conventional femoral lead extraction, providing venous access for introduction of a new pacing/implantable cardioverter-defibrillator (ICD) lead along the channel occupied by the extracted lead.



Any patients requiring lead extraction and immediate replacement of an ipsilateral pacing/ICD system were considered suitable for lead replacement using a “drag through” technique. Patients considered unsuitable were those in whom there was evidence of lead infection, or crushing of the lead between the clavicle and the first rib, reflecting a suboptimal implantation route.

Lead extraction procedure

The procedure was performed under local anaesthetic (with two exceptions, …

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