Byrd Femoral Work Station

BYRD FEMORAL WORK STATION INNER SHEATH... 

There are three fundamental anatomic approaches for lead extraction (23,24,37). The first is retrieval by the implant vein, frequently called the superior approach. This approach can include simple traction. Buck s traction, the use of locking stylets with traction, or the use of locking stylets with countertraction sheaths. The second approach is transfemoial, frequently called the inferior approach. This approach may involve several distinct techniques. When this involves entangling a lead with a pigtail catheter, the catheter is passed from below. When free open ends present themselves, a wire-loop system may be used with traction. Both the Dotter retriever and Dormia basket may also be applied for traction from below. Finally, the lead to be removed may be extracted by the Byrd Femoral Work Station with the use of a combination of snares and wire loops. The third and final approach is retrieval of leads by a limited thoracotomy. 

Fig. 6.23 The Byrd Femoral Work Station, (a) The sheath is seen with its preloaded inner sheath containing a deflecting wire with wire-deflecting handle and Dotter retriever. The Check-Flo valve and side-port are also shown, (b) The distal end of the Byrd Femoral Work Station showing the outer sheath, preloaded inner sheath, Dotter basket, and tip-deflecting wire. (Photographs courtesy of Cook Pacemaker Corp.)...

Fig. 6.24 Illustration of the Byrd Femoral Work Station inserted by the right femoral vein. The relationship of the Byrd femoral sheath, preloaded inner sheath with its Dotter retriever, and handle-activated deflecting wire are shown. (From Belott PH. Endocardial lead extraction A videotape and manual. Armonk, NY Futura Publishing, 1998, with permission.)...

If a free end is encountered, the wire loop snare is passed down the Byrd Femoral Work Station. The wire loop is enlarged and manipulated around the free end (Fig. 6.30). Once the free end is grasped, the wire loop is closed and the free end retracted into the mouth of the catheter, locking it into place (Fig. 6.31). The lead is held tight by the application of a clamp to the wires at the proximal end of the catheter. The catheter and lead are pulled into the Byrd Femoral Work Station. 

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