FEMORAL BAILOUT - PROCEDURAL COMPLICATIONS AND FAILURES
Our practice was to deploy femoral extraction only as a last resort and
as such reserved for the most challenging cases. Under these
circumstances, a relatively high proportion of major complications and
procedure failures in comparison to non-femoral extraction group would
be expected. However, although there was a statistical difference in
major complications between the superior and femoral bailout groups,
there were only 5 major complications directly linked to femoral
extraction, with no reported fatalities and lower 30-day mortality.
El-Chami et al. previously reported a low procedural success rate (58%)
of femoral TLE 9, yet the reason for femoral bailout
procedural outcomes according to the reason for femoral transition were
not provided.
A high proportion of TLE failures and major complications were linked to
abandoned leads and especially RV abandoned leads. On the other hand, we
observed a higher success rate of both abandoned and non-abandoned
atrial leads via the femoral approach. In accordance with our findings,
previous reports have stressed the superior results of femoral TLE of RA
leads over RV leads. Possible explanations for this observation are that
sheaths are better aligned with atrial and coronary sinus leads;
Ventricular leads cannot be easily freed from the myocardium before the
proximal body of ventricular leads has to be pulled down and that scar
tissue engulfing the lead is more abundant in the ventricle20.