1
|
Zhao P, Wang Y, Zeng S. A simple method of axillary venipuncture using single landmark for pacemaker leads implantation. Acta Cardiol 2022:1-4. [PMID: 36222580 DOI: 10.1080/00015385.2022.2119665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Axillary venipuncture for pacemaker lead implantation has been demonstrated to be an effective method without fatal complications encountered with standard subclavian access approach, but the relatively high complexity limits its clinical practicability. OBJECTIVE We are proposing a simple technique for axillary venipuncture using single point on clavicle as anatomical landmark with the possibility of alternative fluoroscopic assisted puncture as a backup. METHODS Connecting point of medial to middle third of clavicle is located as the landmark. Deflected lateral 45°from sagittal line, an 18-guage needle tip is laid on the point and tangential to upper border of clavicle. Penetrated from the hub site, the needle is directed to the landmark at approximately 30-45° relative to body surface for venipuncture. If blind puncture failed, an alternative fluoroscopic method is performed. Upon successful venipuncture, a guide wire is positioned in inferior vena cava and a skin incision and subcutaneous pocket is made at the puncture site. RESULTS Axillary vein puncture was successful for 106 of 113 patients (93.8%) in the study with mean access time of 3.6 ± 1.4 min. In 84 patients (74.3%), the vein was cannulated by blind puncture, and fluoroscopy guided method was required in other 22 patients (19.5%). The puncture of axillary artery occurred in one patient (0.09%) and no haemorrhage was observed after local pressure. No pneumothorax, hemothorax, or brachial plexus injury was found. CONCLUSIONS The approach of axillary vein puncture using single landmark on the clavicle is simple, effective and safe for pacemaker lead implantation.
Collapse
Affiliation(s)
- Peng Zhao
- Department of Cardiology, Medical Center of Chinese Armed Police Force, Tianjin, China
| | - Ying Wang
- Department of Cardiology, Medical Center of Chinese Armed Police Force, Tianjin, China
| | - Shan Zeng
- Department of Cardiology, Medical Center of Chinese Armed Police Force, Tianjin, China
| |
Collapse
|
2
|
Su J, Kusumoto FM, Zhou X, Elayi CS. How to Perform Extrathoracic Venous Access for Cardiac Implantable Electronic Devices Placement: Detailed Description of Techniques. Heart Rhythm 2022; 19:1184-1191. [PMID: 35231611 DOI: 10.1016/j.hrthm.2022.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/02/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Abstract
Venous access is needed for the implantation of cardiac implantable electronic devices (CIED) with endocardial leads. Extrathoracic venous access in the prepectoral region has become the standard of care for CIED implantation because of lower risks for pneumothorax and likely less lead malfunction due to the subclavian crush syndrome. The most common extrathoracic venous access sites in the pectoral region are extrathoracic subclavian vein access, axillary vein access, and cephalic vein access. This review provides a detailed description of the anatomy, technical considerations, and the relative advantages and disadvantages for each of these extrathoracic venous access sites.
Collapse
Affiliation(s)
- Jialin Su
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida; Cardiology Service, Berkshire Medical Center, Pittsfield, Massachusetts
| | - Fred M Kusumoto
- Department of Cardiovascular Disease, Mayo Clinic in Florida, Jacksonville, Florida
| | - Xuan Zhou
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Claude S Elayi
- Electrophysiology Service, CHI Saint Joseph Hospital, Lexington, Kentucky.
| |
Collapse
|
3
|
Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
Collapse
Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| |
Collapse
|
4
|
Abstract
Transvenous approaches for pacemaker and defibrillator lead insertion offer numerous advantages over epicardial techniques. Although the cephalic, axillary, and subclavian veins are most commonly used in clinical practice, they each offer their own set of advantages and disadvantages that leave their usage dependent on patient anatomy and physician preference. Alternative methods using the upper and lower venous circulation have been described when these veins are not available or practical for lead insertion. Until current technology is superseded by leadless pacing systems, the search for the optimal lead insertion technique continues.
Collapse
Affiliation(s)
- Ali Bak Al-Hadithi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Los Angeles, CA 90095, USA
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Los Angeles, CA 90095, USA
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Los Angeles, CA 90095, USA.
| |
Collapse
|
5
|
Hadjis A, Proietti R, Essebag V. Implantation of cardiac resynchronization therapy devices using three leads by cephalic vein dissection approach. Europace 2018; 19:1514-1520. [PMID: 28340223 DOI: 10.1093/europace/euw276] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/05/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Percutaneous subclavian, axillary, and cephalic vein access are all used in conjunction for atrial and ventricular lead implantation, though no standard approach for cardiac resynchronization therapy (CRT) device implantation has been established. We describe an effective and a safe technique for implanting three leads via cephalic vein for CRT pacemaker and/or defibrillator implantations. Methods and results A total of 171 consecutive patients undergoing de novo implantation of CRT pacemaker or defibrillator were included. Cephalic vein access was achieved by dissection and direct visualization. If the cephalic vein was inadequate, alternate means of access was determined after outset of the procedure. Procedural success rates and complications were recorded. Of the 171 de novo CRT implant attempts, 169 (98.8%) patients had successful implantation of all 3 leads on the first attempt. Of the 171 procedural attempts, 150 (87.7%) patients had all 3 leads placed via cephalic vein. Overall, complications occurred in 6 of 171 patients (3.5%) including initial and repeat procedures. These complications included seven lead dislodgements, two cases of diaphragmatic stimulation requiring lead revision, and one coronary sinus dissection without pericardial effusion. There were no cases of pneumothorax, pocket haematoma requiring evacuation, or infection. Conclusion The triple lead via cephalic vein technique is safe and effective when used as a first approach for CRT device implantation.
Collapse
Affiliation(s)
- Alexios Hadjis
- McGill University Health Centre, 1650 Cedar Avenue, Room E5-200, Montreal, Quebec H3G 1A4, Canada
| | | | - Vidal Essebag
- McGill University Health Centre, 1650 Cedar Avenue, Room E5-200, Montreal, Quebec H3G 1A4, Canada.,Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
6
|
Rossato Pegoraro V, Rodrigues Bento Costa E, Fagundes Gouvea Filho LF, Tose Costa Paiva B. Puncture of the Axillary Vein for the Implant for Electronic Cardiac Devices. JOURNAL OF CARDIAC ARRHYTHMIAS 2018. [DOI: 10.24207/jac.v32i1.511_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: The obtaining of venous access for implantation of implantable electronic cardiac devices (IECDs) has been traditionally made by intrathoracic subclavian vein puncture (SVP) or cephalic vein phlebotomy (CVP). Evidence indicates, however, the increased risk of short-term and long-term complications with SVP due to the fact that it is intrathoracic access and the risk of compression of the electrodes by the costoclavicular ligament, leading to different types of defects. CVP, in turn, has been associated with a failure rate that reaches 45%. Axillary vein puncture (AVP) has been described in the literature and is presented here as an alternative to the two techniques mentioned. Methods: A PubMed survey was conducted on articles that mention the AVP, SVP and CVP techniques and compare them to the immediate, short and long term results and success rates for obtaining venous access. Emphasis was placed on comparisons between the various AVP techniques. Conclusion: The AVP technique for obtaining venous access presents some variations among the different authors. It has CVP-like safety, success rates comparable to those of the subclavian vein, and better medium and long term results for electrode function.
Collapse
|
7
|
Rossato Pegoraro V, Rodrigues Bento Costa E, Fagundes Gouvea Filho LF, Tose Costa Paiva B. Punção da Veia Axilar para o Implante de Dispositivos Cardíacos Eletrônico. JOURNAL OF CARDIAC ARRHYTHMIAS 2018. [DOI: 10.24207/jac.v32i1.511_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introdução: A obtenção do acesso venoso para implante de dispositivos cardíacos eletrônicos implantáveis (DCEIs) tem sido tradicionalmente feita por meio da punção da veia subclávia intratorácica (PVS) ou por fl ebotomia da veia cefálica (FVC). Evidências apontam, entretanto, para o risco aumentado de complicações a curto e longo prazos com a PVS pelo fato de ser um acesso intratorácico e pelo risco de compressão dos eletrodos pelo ligamento costoclavicular, levando a diferentes tipos de defeitos. A FVC, por sua vez, tem sido associada à taxa de insucesso que chega a 45%. A punção da veia axilar (PVA) tem sido descrita na literatura e é apresentada, aqui, como alternativa às duas técnicas mencionadas. Métodos: Realizou-se uma pesquisa pelo PubMed sobre artigos que mencionam as técnicas de PVA, PVS e FVC e que as comparam quanto aos resultados imediatos, a curto e longo prazos e taxas de sucesso para a obtenção do acesso venoso. Deu-se ênfase às comparações entre as diversas técnicas de PVA. Conclusão: A técnica de PVA para obtenção do acesso venoso apresenta algumas variações entre os diversos autores. Ela tem segurança semelhante à da FVC, taxas de sucesso comparáveis às da veia subclávia e melhores resultados a médio e a longo prazos para a função dos eletrodos.
Collapse
|
8
|
Embryological and comparative description of the cephalic vein joining the external jugular vein: A case report. Morphologie 2017; 102:44-47. [PMID: 29133232 DOI: 10.1016/j.morpho.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/08/2017] [Accepted: 10/10/2017] [Indexed: 11/21/2022]
Abstract
The cephalic vein arises from the radial end of the dorsal venous arch. It turns around the radial border of the forearm and passes proximally along the arm to the shoulder, where it enters the axillary vein by penetrating the clavipectoral triangle. The cephalic vein is prone to vary at the antecubital fossa, where it forms numerous anastomoses. A male cadaver fixated with a 10% formalin solution was dissected during regular anatomy lessons. It was found that the cephalic vein crossed the upper third of the arm between two fasciculi of the deltoid muscle and reached the shoulder, where it passed above the acromion and crossed the posterior border of the clavicle in order to join the external jugular vein. The cephalic vein is one of the most used veins for innumerous activities, such as venipunctures and arteriovenous fistula creation. Furthermore, it is an anatomical landmark known for its consistent anatomy, as it possesses low rates of variability. Despite that, its anatomical variations are clinically and surgically significant and healthcare professionals must be aware of the variations of this vessel. We aim to report a rarely described variation of the cephalic vein and discuss its embryological, phylogenetic and clinical features.
Collapse
|
9
|
Liu P, Zhou YF, Yang P, Gao YS, Zhao GR, Ren SY, Li XL. Optimized Axillary Vein Technique versus Subclavian Vein Technique in Cardiovascular Implantable Electronic Device Implantation: A Randomized Controlled Study. Chin Med J (Engl) 2017; 129:2647-2651. [PMID: 27823994 PMCID: PMC5126153 DOI: 10.4103/0366-6999.193462] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The conventional venous access for cardiovascular implantable electronic device (CIED) is the subclavian vein, which is often accompanied by high complication rate. The aim of this study was to assess the efficacy and safety of optimized axillary vein technique. METHODS A total of 247 patients undergoing CIED implantation were included and assigned to the axillary vein group or the subclavian vein group randomly. Success rate of puncture and complications in the perioperative period and follow-ups were recorded. RESULTS The overall success rate (95.7% vs. 96.0%) and one-time success rate (68.4% vs. 66.1%) of punctures were similar between the two groups. In the subclavian vein group, pneumothorax occurred in three patients. The subclavian gaps of three patients were too tight to allow operation of the electrode lead. In contrast, there were no puncture-associated complications in the axillary vein group. In the patient follow-ups, two patients in the subclavian vein group had subclavian crush syndrome and both of them received lead replacement. The incidence of complications during the perioperative period and follow-ups of the axillary vein group and the subclavian vein group was 1.6% (2/125) and 8.2% (10/122), respectively (χ2 = 5.813, P = 0.016). CONCLUSION Optimized axillary vein technique may be superior to the conventional subclavian vein technique for CIED lead placement. TRIAL REGISTRATION www.clinicaltrials.gov, NCT02358551; https://clinicaltrials.gov/ct2/show/NCT02358551?term=NCT02358551& rank=1.
Collapse
Affiliation(s)
- Peng Liu
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yi-Feng Zhou
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Peng Yang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yan-Sha Gao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Gui-Ru Zhao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shi-Yan Ren
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xian-Lun Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|