PROCEDURAL OUTCOMES
Clinical and radiological success between approach groups was not compared as femoral bailout group represents extraction failure of superior approach methods. Only 7 patients who hadn’t suffered major complication or death[7/421 (1.7%)] had superior approach clinical\radiological failure without a femoral attempt.
A total of 928 leads were extracted in our cohort with 71 via a femoral position. The operator decision to switchover to femoral bailout intra-procedurally was carried out when the superior approach was not fully successful for the following reasons: 37 of the 71 leads were extracted via femoral bailout because of lead breakage(unrelated to known vascular obstruction) occurring during the procedure itself. 19 leads were extracted via a femoral bailout because of vascular occlusion causing either inability to pass and deploy tools or lead breakage. Finally, in 15 leads femoral bailout was deployed due to inability to extract the lead from the superior approach without causing lead breakage.
RV leads comprised most[499/928 (53.8%)] of leads extracted(Figure 1). A higher proportion of RV leads had to be extracted from a femoral approach compared with RA leads[51/499(10.2%) vs 18/326(5.5%);p=0.02]. A small fraction of left ventricular(LV) leads [2/103(1.9%)] were extracted via the femoral access.
Abandoned leads comprised roughly 10 percent [91/928 (9.8%)] of the extracted leads in our cohort. One third [30/91 (33%)] of them were extracted transfemorally. The overall clinical success rates of transfemoral abandoned leads extraction were much lower than non-abandoned leads[22/30(73.3%) vs 40/41(97.6%);p<0.01].
Femoral bailout had a higher overall[18/18 (100%)] clinical success of RA leads compared to RV leads[43/51(84.3% )](Figure 2). The 2 LV leads requiring femoral bailout were extracted successfully. Clinical[18/25(72%)] and radiological[11/25 (44%)] success rates of femoral bailout extraction of RV abandoned leads was exceptionally low.
All leads which were extracted via femoral approach due to vascular occlusion had full radiological success[19/19(100%)], while only roughly half of patients with femoral bailout due to lead breakage that occurred during the procedure achieved radiological success[19/37(51.3%)](figure 3).