Fluoroscopy-Guided Axillary Vein Puncture, a Reliable Method to Prevent Acute Complications Associated With Pacemaker, Defibrillator, and Cardiac Resynchronization Therapy Leads Insertion

E.M Malitha S Hettiarachchi

doi:10.4172/2329-9517.1000136

Abstract

Introduction: The subclavian venous approach is a widely used method for venous access in device implantation and is associated with pneumothorax as a short term complication and lead fracture as a long term complication. The axillary vein approach is an alternate method for venous access, and this study evaluates the successfulness and immediate complications of fluoroscopy-guided axillary vein puncture compared to other venous approach methods. Methods: This is a retrospective observational study on all patients who underwent pacemaker, defibrillator implant or lead change over 23 months. The fluoroscopy-guided modified Seldinger technique was used for axillary vein puncture and if failed, venography was performed. Results: Out of 261 device implants or lead changes, 210 patients underwent fluoroscopy-guided axillary vein puncture. The mean age of the patients was 65.43 ± 15.7 years; 96.1% were African American; 57.6% were males. In 194 (92.3%) patients left or right axillary vein approaches were successful by either fluoroscopy or venography guidance. When anatomical abnormalities were excluded the success rate for axillary vein puncture was 97% and for fluoroscopy-guided axillary vein puncture was 94.5 %. Multiple leads were placed without any resistance and none of the patients had pneumothorax, hemothorax or hematoma as immediate complications. Conclusion: Based on this first study conducted in a relatively large consecutive United Sates patient population, we report that fluoroscopy-guided axillary vein puncture using the first rib as a landmark, is a safe and effective method for device implantation with single or multiple leads, without patients getting exposed to intravenous contrasts.

Highlights

The subclavian venous approach is a widely used method for venous access in device implantation and is associated with pneumothorax as a short term complication and lead fracture as a long term complication
We present our single center experience in fluoroscopy-guided axillary vein puncture using the modified Seldinger technique
Out of 210 patients who had axillary vein approach attempted, in 194 patients (92.3%) left or right axillary vein approaches were successful by either fluoroscopic or venography guidance (Table 1 and Figure 4)

Summary

Introduction

The subclavian venous approach is a widely used method for venous access in device implantation and is associated with pneumothorax as a short term complication and lead fracture as a long term complication. The axillary vein approach is an alternate method for venous access, and this study evaluates the successfulness and immediate complications of fluoroscopy-guided axillary vein puncture compared to other venous approach methods. Infraclavicular subclavian approach, cephalic vein cut down, and axillary vein puncture are accepted methods for implanting endocardial pacemaker and transvenous defibrillator leads. Cephalic cut down has been shown to be associated with a lower incidence of lead fracture but the cephalic venous approach requires skills in surgical cut-down technique and the vessel’s smaller diameter makes insertion of multiple large diameter leads more technically demanding [7]. Experience with axillary vein approach is mainly clinical and limited, and immediate and long term complications over other methods are not well established in observational studies [8,9]

Methods

Results

Discussion

Conclusion