Caudal fluoroscopy to guide venous access for pacemaker device implantation: should this now be standard practice?

Patel, Hitesh; Hayward, Carl; Nanayakkara, Shane; Broughton, Archer; Mariani, Justin A.

doi:10.1136/heartasia-2017-010881

Cited by 5 publications

(7 citation statements)

References 6 publications

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“…Adding 30°-35° of caudal angulation to A-P projection (caudal fluoroscopy) has been proposed to obviate these shortcomings. The feasibility and safety of this technique has been described previously [3][4][5]. In their experience of 229 consecutive CIED implants using caudal fluoroscopy, Yang and Kulback did not report any case which was complicated with pneumothorax [4].…”

Section: Discussionmentioning

confidence: 99%

“…The perceived space available to manipulate the needle between the first rib and clavicle is foreshortened and the perception of depth required for puncture is lacking in this view. This is particularly worrisome in elderly patients or patients with large body habitus, thoracic cage abnormalities like kyphoscoliosis or chronic obstructive airway disease with significant lung hyperinflation [3].…”

Section: Discussionmentioning

confidence: 99%

“…In their experience of 229 consecutive CIED implants using caudal fluoroscopy, Yang and Kulback did not report any case which was complicated with pneumothorax [4]. Subsequently, in a larger series by Patel et al [3], pneumothorax occurred in only 0.2% of cases, thereby highlighting the benefit of caudal fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…However, this approach in the A-P view still carries a risk of pneumothorax. Adding 30°-35° of caudal angulation to A-P projection on fluoroscopy (referred to as caudal fluoroscopy hereafter) has been shown to address these shortcomings [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Utility of Caudal Angulation for Venous Access under Fluoroscopic Guidance during Cardiovascular Implantable Electronic Device Implantation

et al. 2021

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Background: Axillary venous access is preferred for CIED implantation. The procedure is usually performed under fluoroscopic guidance in anteroposterior (A-P) view. However, there is a lack of perception of depth in this view with a fear of creating complications. Caudal fluoroscopy (adding 30°–35° caudal angulation to A-P projection) has been proposed to circumvent this problem. Objective: The aim of this study was to elucidate the advantages of caudal fluoroscopy using fluoroscopic images, contrast venograms, and CT angiography images of axillary vein. Methods: The fluoroscopic images and contrast venograms obtained in the A-P view were compared with caudal fluoroscopy in patients undergoing CIED implantation at our centre. Also, the CT angiography images of axillary vein were reconstructed to understand the relative anatomy of the vein and the underlying lung parenchyma, simulating these 2 projections. Results: The CT angiography images, contrast venograms, and fluoroscopic images confirmed that caudal fluoroscopy allows better visualization of the vein in relation to the lung parenchyma and rib cage. Analysis of fluoroscopic images revealed that the bend of the first rib formed a conical prominence in caudal fluoroscopy. This served as an important bony landmark for successful venous access, which was usually obtained while the needle was being directed towards this prominence in caudal fluoroscopy. Conclusions: The proposed advantages of caudal fluoroscopy for CIED implantation have been elucidated by analysis of CT angiography images, contrast venograms, and fluoroscopic images.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of Caudal Angulation for Venous Access under Fluoroscopic Guidance during Cardiovascular Implantable Electronic Device Implantation

et al. 2021

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“…Procedures were performed by eight experienced consultant cardiologists who had each performed greater than 500 CIED procedures: five used caudal fluoroscopy routinely, three used exclusively AP fluoroscopy. The caudal technique used was similar to that originally described by Patel et al in 2017 2 . With the patient in the supine position, an incision in proximity to the roof of the deltopectoral triangle was made and a pre‐pectoral pocket was fashioned in the usual manner to expose the pectoral muscle and adjacent fascia.…”

Section: Methodsmentioning

confidence: 99%

Caudal fluoroscopic guidance for the insertion of transvenous pacing leads

Morton,

William,

Kistler

et al. 2024

Cardiovasc electrophysiol

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BackgroundPneumothorax is a well‐recognized complication of cardiac implantable electronic device (CIED) insertion. While AP fluoroscopy alone is the most commonly imaging technique for subclavian or axillary access, caudal fluoroscopy (angle 40°) is routinely used at our institution. The caudal view provides additional separation of the first rib and clavicle and may reduce the risk of pneumothorax. We assessed outcomes at our institution of AP and caudal fluoroscopic guided pacing lead insertion.MethodsRetrospective cohort study of consecutive patients undergoing transvenous lead insertion for pacemakers, defibrillators, and cardiac resynchronization therapy devices between 2011 and 2023. Both de novo and lead replacement/upgrade procedures were included. Data were extracted from operative, radiology, and discharge reports. All patients underwent postprocedure chest radiography.ResultsThree thousand two hundred fifty‐two patients underwent insertion of pacing leads between February 2011 and March 2023. Mean age was 71.1 years (range 16–102) and 66.7% were male. Most (n = 2536; 78.0%) procedures used caudal guidance to obtain venous access, while 716 (22.0%) procedures used AP guidance alone. Pneumothoraxes occurred in five (0.2%) patients in the caudal group and five (0.7%) patients in the AP group (p = .03). Subclavian contrast venography was performed less frequently in the caudal group (26.2% vs. 42.7%, p < .01).ConclusionCaudal fluoroscopy for axillary/subclavian access is associated with a lower rate of pneumothorax and contrast venography compared with an AP approach.

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Editorial Comment to: Perioperative complications after pacemaker implantation: Higher complication rates with subclavian vein puncture than with cephalic vein cut-down (Hasan et al.)

Malyshev

Yang

2022

J Interv Card Electrophysiol

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Caudal fluoroscopy to guide venous access for pacemaker device implantation: should this now be standard practice?

Cited by 5 publications

References 6 publications

Utility of Caudal Angulation for Venous Access under Fluoroscopic Guidance during Cardiovascular Implantable Electronic Device Implantation

Utility of Caudal Angulation for Venous Access under Fluoroscopic Guidance during Cardiovascular Implantable Electronic Device Implantation

Caudal fluoroscopic guidance for the insertion of transvenous pacing leads

Editorial Comment to: Perioperative complications after pacemaker implantation: Higher complication rates with subclavian vein puncture than with cephalic vein cut-down (Hasan et al.)

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