Retained Wire Lead Extraction Techniques in Patients With Venous Occlusion

BACKGROUND: Venous occlusion is a common consequence of chronic indwelling cardiovascular implantable electronic device (CIED) leads within the venous system, posing a significant barrier to lead revision or system upgrade. Traditional options for regaining access, such as transvenous lead extraction (TLE), epicardial systems, or contralateral tunneling, are associated with increased morbidity or technical complexity. Retained wire techniques, which leverage preexisting leads to traverse occlusions, represent a practical alternative, but data remain limited. OBJECTIVES: This study sought to evaluate the feasibility, safety, and outcomes of 4 retained wire techniques, each combined with venoplasty, for re-establishing venous access in patients with complete venous occlusion undergoing CIED revision or upgrade. METHODS: This retrospective study included patients undergoing TLE for CIED revision or upgrade at a single center (2020 to 2025) with complete venous occlusion. Retained wire techniques included wire-under-insulation (above or below), wire-in-lumen, and wire-through-coronary sinus lead. Venoplasty was performed in most cases following successful wire placement. RESULTS: Among 60 eligible patients, 50 (83%) had leads that were freely mobile and underwent a retained wire strategy. Access was successfully re-established in 49 of 50 cases (98%). Wire-in-lumen was most effective (35 of 36, 97%), whereas wire-under-insulation from above had limited success (3 of 9, 33%). Venoplasty was performed in 92% of cases. One pericardial effusion occurred requiring pericardiocentesis. CONCLUSIONS: Retained wire techniques offer a safe and effective solution for managing venous occlusion during CIED revision or upgrade, particularly when leads are mobile and dwell time is modest. The wire-in-lumen technique demonstrated the highest success and broadest applicability.