Femoral approach to lead extraction.

Laser and radiofrequency energy-assisted lead extraction has greatly facilitated this complex procedure. Although success rates are high, in some instances alternate methods of extraction are required. In this review, we discuss techniques for femoral extraction of implanted leads and retained fragments. The major tools available, including commonly used snares and delivery tools, are discussed. We briefly describe combined internal jugular and femoral venous extraction approaches, as well as complimentary utilization of more than one technique via the femoral vein. Animated and procedural sequences are included to help the reader visualize the key components of these techniques.

Abnormal origin of right coronary artery and use of Tiger catheter through femoral route.

BACKGROUND: Abnormal origin of right coronary artery (RCA) is not uncommon. The incidence is .25-.92%. Right Judkin catheter is used universally for engaging right coronary ostium from femoral route. We have tried Tiger catheter from femoral route in abnormal origin of RCA patients. We were successful in cannulating RCA ostium in most of the cases. MATERIALS AND METHODS: We have studied about 5120 patients over 4 years. We have selected patients from November 2010 to November 2014. Our patients are from two institutions-I.P.G.M.E.R., Kolkata and Burdwan Medical College, West Bengal. Right Judkin 3.5 and 4 were used universally. We have used AL-1,2,3, AR1,2, multipurpose, different guide catheters for cannulating RCA ostium in those cases where we failed to engage by right Judkin catheter. We have used Tiger catheter as a last resort when all endeavor failed. RESULTS AND ANALYSIS: Among 40 cases of left sinus origin Type A-9, Type B-14, Type C-6, Type D-3, and Type E-8 patients were observed. But 668 cases abnormal origin of RCA were from right coronary sinus only. High take-off origin were 422 cases (8%), low take-off were 132 cases (2.5%), and posterior origin were 114 cases (2%). We could engage right coronary ostium by Tiger catheter in 690 cases (97%). We failed in 23 cases (3%). CONCLUSION: Tiger catheter can be used successfully in abnormal RCA origin cases. It is more effective but less risky in comparison to other catheters.