Extraction of abandoned, potentially dangerous lead with uncovered proximal ending: a case report and method description.

In this study, we present the case of the extraction of a non-functioning, abandoned, chronically implanted nine year-old lead with proximal extended frayed ending, displaced spontaneously into the subclavian vein. The seemingly inaccessible lead was extracted from the body using the femoral approach. The lead was looped with a pig-tail catheter, standard guide-wire, and basket Dotter catheter, and the proximal ingrown ending was liberated. Finally, it was grasped with a basket catheter and its tip was liberated using oblique cut rotated internal sheath of a Femoral Working Station: using it as a Byrd dilator designed for subclavian approach. An additional difficulty was the risk of dislodging the correct endocardial lead in the pacemaker-dependent patient. The procedure indicates the necessity for the production of longer Byrd dilators designed for the femoral approach.