Axillary Vein Puncture Without Contrast Venography for Pacemaker and Defibrillator Leads Implantation

Antonelli, Dante; Feldman, Alexander; Freedberg, Nahum A.; Turgeman, Yoav

doi:10.1111/pace.12181

Cited by 45 publications

(52 citation statements)

References 12 publications

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“…Subsequently, various different techniques of axillary vein approach have been proposed ranging from a blind percutaneous puncture to the use of different tools such as contrast venography and ultrasound [10,[21][22][23][24][25][26]. Belott [23] described a technique for blind axillary vein puncture using anatomic landmarks by placing the needle tip fluoroscopically over the middle of the first rib prior to needle advancement through the pectoralis major muscle and maintaining this position by adjusting to a steeper needle angle when advancing to touch the rib.…”

Section: Discussionmentioning

confidence: 99%

Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads

Migliore

Siciliano

Lazzari

et al. 2015

J Interv Card Electrophysiol

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Section: Discussionmentioning

confidence: 99%

Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads

Migliore

Siciliano

Lazzari

et al. 2015

J Interv Card Electrophysiol

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“…Our study used the first rib as landmark, not the second rib, and therefore this method prevented excessive bleeding at the puncture site and allowed for better and easier lead fixation. Although this could be considered as a technique sometimes used in the clinical practice, we have done a thorough literature review, and we found only one retrospective chart review published study conducted in a smaller patient population in Israel, that used the most lateral edge of the first rib as a fluoroscopic landmark [13].…”

Section: Discussionmentioning

confidence: 99%

“…Out of the small number of published data on axillary vein puncture most are non United States smaller scale studies that compare various methods, namely, the contrast venography-guided, the Dopplerguided, and the ultrasound-guided puncture methods except for a few studies done in Israel, Japan and India with fluoroscopy-guided Total device/lead change 261 approach [9,11,[13][14][15]. This study is a North-American experience with fluoroscopy-guided axillary vein puncture using the first rib as a landmark; it is done in a relatively large African-American population, and discusses the immediate complications of the procedure.…”

Section: Discussionmentioning

confidence: 99%

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

Hettiarachchi¹,

Arsene²,

Fares³

et al. 2014

J Cardiovasc Dis Diagn

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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.

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“…2,3 Various fl uoroscopic approaches have been described with very high success rates. 4 We therefore believe that axillary venous access is safe, useful, easy to learn and therefore of use to all physicians performing central venous access techniques. ■ …”

Section: Cardiology Registrars and Permanent Pacemaker Complication Rmentioning

confidence: 95%

Cardiology registrars and permanent pacemaker complication rates

2014

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Cardiology registrars and permanent pacemaker complication ratesEditor -We read with interest the article by Leong et al exploring complication rates in the 12 weeks after pacemaker implantation in a UK district hospital (Clin Med February 2014 pp 34-7). We highlight a later complication that can occur and how to avoid it using a technique which will also be of interest to all physicians performing central venous access techniques. In the Leong study the subclavian vein was the most frequent route utilised for venous access. As found in this study there is a small risk of pneumothorax. However, in the longer term it also conveys a small risk of a 'crush' injury to the pacemaker lead. 1 This is thought to be a result of pressure exerted between the fi rst rib and the clavicle on the lead just before it enters the vein. The fi rst author of this letter has experience of this complication, resulting in transection (Fig 1a and b).A different approach utilises the axillary vein (Fig 1c). As the puncture is extra-thoracic, there is no longer a risk of crush injury and the risk of pneumothorax is reduced. A number of methods allowing access to this vessel have been described. It can be identifi ed using ultrasound (Fig 1d) with a number of papers describing ultrasound guided insertion with up to 100% success rates, short operator learning curves and low complication rates. 2,3 Various fl uoroscopic approaches have been described with very high success rates. 4 We therefore believe that axillary venous access is safe, useful, easy to learn and therefore of use to all physicians performing central venous access techniques. ■ DANIEL M SADO StR in cardiology,

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Axillary Vein Puncture Without Contrast Venography for Pacemaker and Defibrillator Leads Implantation

Abstract: Our approach of axillary venipunture using fluoroscopic landmark, without contrast venography, is simple, safe, and effective.

Cited by 45 publications

References 12 publications

Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads

Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads

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

Cardiology registrars and permanent pacemaker complication rates

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