B-PO04-043 NOVEL SNARE TECHNIQUE FOR LEAD EXTRACTION

Abstract

Lead extraction is complex and may require snaring of leads for counter-traction or removal. To describe a novel snare created with commonly used wires and sheaths for counter-traction and complete lead removal. N/A A 60-year-old man presented for lead extraction of a dual coil, right ventricular ICD lead. Snaring of the lead to provide counter-traction during extraction was deemed necessary; however, the typically used needle-eye snare was unavailable. An 8.5 Fr-71 cm Agilis sheath was advanced through the right femoral vein via a 16 French outer sheath. A decapolar catheter within the Agilis sheath was looped around the RV lead, followed by advancement of the Agilis sheath (A). Once the Agilis sheath was around the lead (B), the catheter was replaced with an exchange-length Glidewire that was advanced to the IVC (C), and the Agilis was pulled back. The free end of the Glidewire was snared (D) and pulled out of the sheath; the Agilis sheath which was then advanced over both ends of the wire to create an adjustable loop around the lead with the tip of the sheath acting as the snare catheter (E). The lead was successfully extracted by applying counter-traction using the robust novel snare. The Glidewire loop was released once the extraction sheath reached the area of the snare (F). In a situation where the lead breaks, the snare itself could be used to pull the sheath into a 16 Fr (or larger) long sheath, thereby precluding the need to use any other snare. With the help of a Glidewire and an Agilis sheath, a snare can be created that can be used to provide counter-traction. If the lead breaks, this snare allows complete removal through a large outer sheath.