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.