Video-Assisted Thoracoscopic Monitoring of Laser Lead Extraction by Femoral Route

A 72-year-old man with a dual-chamber implantable defibrillator was referred to our center for transvenous lead extraction because of pocket infection and presence of an abandoned lead. We decided to proceed with a video-assisted thoracoscopic approach because of patient history and documented complete occlusion of the right subclavian vein. During the use of excimer laser for persistent adhesions, the ventricular lead broke down at the level of cavoatrial junction. To successfully remove the remaining portion of lead, we decided to use the excimer laser by femoral route. A final angiography through the laser sheath showed the integrity of the myocardial wall. We report a case of laser-assisted transvenous lead extraction unconventionally performed by the femoral route. A preventive minimally invasive cardiac surgery was implemented to provide more safety in this high-risk procedure. This technique may avoid the need of a full sternotomy in case of major bleeding complications.