Mdaihly Mohamad, Watfa Adele, Younis Arwa, Demian Joe, Callahan Thomas D, Motairek Issam, Tabaja Chadi, Santangeli Pasquale, Baranowski Bryan, Taigen Tyler Louis, Martin David O, Nakhla Shady, Kanj Mohamed, Bhargava Mandeep, Saliba Walid I, Wazni Oussama M, Hussein Ayman A
Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Heart Rhythm. 2025 Jun 3. doi: 10.1016/j.hrthm.2025.05.061.
Transvenous lead extraction (TLE) remains a complex procedure most commonly performed via the superior approach using the initial implant vein. The femoral approach is typically used as a "bailout" strategy aiming to increase success rate.
The study aimed to evaluate the procedural outcomes and factors associated with the "bailout" femoral approach in TLE.
In a prospectively maintained registry, we included all patients undergoing TLE at our center between 1996 and 2022. Patients were categorized into 2 groups: superior approach alone vs superior with a femoral bailout approach. Procedural outcomes and safety were compared between the groups.
Among 4989 patients undergoing TLE, we identified 163 patients (3.3%) requiring a "bailout" femoral approach. These patients had a longer combined age of leads (26.02 ± 20.31 vs 13.68 ± 13.37 years, P < .001), older age of oldest lead (12.60 ± 8.15 vs 7.27 ± 5.80 years, P < .001), and a greater total number of targeted leads for TLE (2.66 ± 1.06 vs 2.05 ± 0.89, P < .001). Infection was more likely to be the indication for extraction in the femoral group (54.6% vs 39.9%, P < .001). By adding the femoral workstation, the cumulative clinical success increased from 96.4% to 99.1%, whereas the procedural success from 94.6% to 97.3%, despite lower success rates within the femoral group itself. No significant differences were observed in the rates of major (3.1% vs 2.8%, P = .83) or minor complications (3.7% vs 2.9%, P = .54) between the groups.
The "bailout" femoral approach in TLE enabled complete extraction of leads in a large proportion of patients undergoing TLE with a similar safety profile compared with the superior-only approach, despite more complex procedures.
经静脉导线拔除术（TLE）仍然是一项复杂的操作，最常通过使用初始植入静脉的头端入路进行。股静脉入路通常用作一种“补救”策略，旨在提高成功率。
本研究旨在评估TLE中“补救”股静脉入路的手术结果及相关因素。
在一个前瞻性维护的登记系统中，我们纳入了1996年至2022年间在本中心接受TLE的所有患者。患者被分为两组：单纯头端入路组与头端联合股静脉补救入路组。比较两组的手术结果和安全性。
在4989例接受TLE的患者中，我们确定了163例（3.3%）需要“补救”股静脉入路。这些患者的导线总年限更长（26.02±20.31年 vs 13.68±13.37年，P<.001），最老导线的年限更大（12.60±8.15年 vs 7.27±5.80年，P<.001），且TLE的目标导线总数更多（2.66±1.06根 vs 2.05±0.89根，P<.001）。感染更有可能是股静脉组导线拔除的指征（54.6% vs 39.9%，P<.001）。通过增加股静脉工作站，累积临床成功率从96.4%提高到99.1%，而手术成功率从94.6%提高到97.3%，尽管股静脉组本身的成功率较低。两组之间在严重并发症（3.1% vs 2.8%，P=.83）或轻微并发症（3.7% vs 2.9%，P=.54）发生率方面未观察到显著差异。
TLE中的“补救”股静脉入路能够使大部分接受TLE的患者成功完全拔除导线，与单纯头端入路相比，安全性相似，尽管手术操作更为复杂。
