# Transvenous Lead Extraction: The Femoral Pull‐Through Technique

## TL;DR

A new technique for safely extracting infected heart device leads through the femoral vein is described.

## Contribution

A novel femoral pull-through technique for transvenous lead extraction is introduced and successfully applied.

## Key findings

- The femoral pull-through technique allowed safe extraction of a passive fixation atrial lead.
- The method enabled linear alignment of the extraction sheath, improving traction application.
- The technique was effective without causing complications.

## Abstract

Transvenous lead extraction (TLE) plays a significant role in maintaining device therapy. Conventional extraction involves advancing an extraction sheath via the implanting vein over the targeted lead, however advanced techniques involve the use of the jugular and femoral accesses which provide geometrical advantages. Femoral extraction can be used as a “bail‐out” and a primary extraction strategy but with significant challenges.

We present a novel technique, transferring a 20‐year‐old passive fixation atrial lead with a deployed locking stylet from the subclavian vein to the femoral site, to complete the extraction of an infected system.

Transfer of the lead from the implanting vein to the femoral vein, permitted linear alignment of the femoral sheath to the passive fixation atrial lead, safely enhancing the application of traction and counter‐traction. The lead was extracted without sequalae.

The femoral pull‐through technique is safe and effective, with potential application in a range of scenarios.