The different forms of the left brachiocephalic vein visualised during cardiovascular implantable electronic device implantation procedures.

Abstract

Among the factors ensuring successful completion of such minimally invasive procedures as cardiac implantable electronic device (CIED) implantation and central venous catheter (CVC) placement are the morphometry and topography of the vessels used for cardiac lead or catheter advancement. Venous access through the left clavipectoral triangle makes use of the left brachiocephalic vein (BCV). The purpose of this study was to present the radiology images of various individual forms of this vessel observed during CIED implantation procedures. Our analysis included 100 venography recordings illustrating the left BCV, obtained during de novo CIED implantation procedures. We assessed the mediastinal course of the left BCV, with its natural angles, including angle α (in the middle section of the vessel) and the two angles created by the left BCV and the left subclavian vein (angle β) and the left BCV and the superior vena cava (angle γ). The mean values of angle α tended to be higher (approximately 141°) than those of the two remaining angles (γ and β), which were comparable at 123° and 127°, respectively. An increase in mean angle α values were accompanied by increased mean angle γ and β values (p = 0.05), with only 5% of β and γ angles, in total, having values close to those of a right angle (90 ± 10º). Individual variability of left BCV topography and morphology comes from developmental formation of the physiological angle in the middle section of this mediastinal vessel's course. The presence of near-right angles along the course of left BCV may potentially result in injuries to the vessel during intravascular procedures.