Guidewire–Suture Traction Reconstruction for Intraoperative Lead Disruption During TLE: A Case-Based Bailout Technique

Intraoperative lead disruption during transvenous lead extraction (TLE) may result in an abrupt loss of traction and prevent the safe advancement of extraction sheaths. Standard lead-control strategies include simple or locking stylet support, whereas dedicated lead extenders may be used in selected cases when proximal lead control is lost. We describe a case-based guidewire–suture traction reconstruction technique used as a bailout maneuver after intraoperative lead disruption. In the present case, initial manual traction using a simple stylet failed to provide adequate lead control. A locking stylet was subsequently inserted through the initially intact lead lumen, and extraction was continued using a 13F mechanical dilator sheath. However, the lead body was disrupted while the locking stylet was already in place, resulting in the loss of effective proximal traction and making further intraluminal lead-control maneuvers impossible. A stiff guidewire was then secured to the disrupted lead segment using multiple firm sutures, creating an artificial traction backbone and restoring the rail effect required for controlled sheath advancement. The reconstructed guidewire–lead complex enabled the successful completion of the extraction without procedural complications. This case describes guidewire–suture traction reconstruction as an exceptional bailout strategy after intraoperative lead disruption during TLE. The method is not intended to replace standard intraluminal support, dedicated lead-control tools, or manufacturer-approved extraction systems. Its use should be limited to highly selected circumstances, performed only by experienced TLE operators with surgical backup, and interpreted as a single-case technical experience rather than a generalizable recommendation. Further bench testing and clinical experience are required before broader conclusions regarding its safety, reliability, or reproducibility can be drawn.

Keywords: Bailout technique, lead disruption, lead fracture, traction reconstruction, transvenous lead extraction.