Contrast venography vs. microwire assisted axillary venipuncture for cardiovascular implantable electronic device implantation

Beig, Jahangir Rashid; Ganai, B.; Alai, Mohammad S.; Lone, Ajaz; Hafeez, Imran; Dar, Mohd Iqbal; Tramboo, Nisar A.; Rather, Hilal

doi:10.1093/europace/eux215

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…Technique modifications led to the uptake of imaging guidance, including fluoroscopy, ultrasound, and contrast venography. However, despite these advancements, reported rates of pneumothorax with axillary/subclavian puncture remain between 0% and 2.3% 1,8–19 …”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Caudal fluoroscopic guidance for the insertion of transvenous pacing leads

Morton,

William,

Kistler

et al. 2024

Cardiovasc electrophysiol

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“…Compared to data previously reported in the literature, the incidence of axillary puncture complications in our study was similar to that previously reported. [19][20][21] The complications occurred in some elderly, malnourished patients. The lower incidence of complications can be explained by our preferred method of obtaining axillary venous access which is roadmap guiding strategy to allow real-time visualization.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of axillary vein puncture real-time guided by roadmap fluoroscopy in cardiac pacemaker implantation

Chen

Zhang

et al. 2022

Preprint

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Objective: Roadmap fluoroscopy has never previously been evaluated for axillary vein puncture in clinical practice. Our retrospective cohort study was performed to investigate the efficacy and safety of axillary vein puncture real-time guided by roadmap fluoroscopy in cardiac pacemaker implantation. Methods and Results: A total of 178 patients undergoing axillary vein puncture in permanent pacemaker implantation were included in the present cohort study during a 1-year period at our institution. All procedures were performed by the operators with previous experience in axillary approach. Primary endpoint was defined as axillary vein success rate. Secondary endpoints were venous access site change, time to obtain venous access, procedural time, and complication rate. For the primary outcomes, a higher success rate was observed in the roadmap group compared with the blind puncture group (95.2% vs 78.7%; P<0.001), as well as a lower rate of venous access site change (7.1% vs 35.1%; P <0.001) and shorter time to obtain venous access and procedural time, with lower complications (3.6 % vs 6.4 %; P<0.01). Conclusion: The roadmap fluoroscopy real-time guided axillary venous access is safer and has a better success rate and faster execution time compared with the blind axillary puncture in cardiac pacemaker implantation. However, further larger scale prospective randomized controlled trials are required to confirm the findings.

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“…A microwire introduced from the antecubital vein can be used as an alternate fluoroscopic landmark. 4 Depending on the X‐ray angle there is also a persisting but low risk for pneumothorax. Usually, the operator aims for the first or second ribs and can use a caudal view to ensure the needle trajectory is extrathoracic.…”

Section: Venography For Axillary Vein Cannulationmentioning

confidence: 99%

“… 1 The traditional anatomic based approach for subclavian vein puncture is particularly associated with an increased risk. 2 , 3 These risks could be reduced by accessing the axillary vein and not the subclavian vein using a venogram based approach, 4 , 5 , 6 , 7 or by an ultrasound based approach for lead insertion 4 , 6 , 7 , 8 or cephalic vein cut down. 4 , 5 , 6 , 7 Most implanters prefer cephalic cutdown as their initial approach.…”

mentioning

confidence: 99%

“…2 , 3 These risks could be reduced by accessing the axillary vein and not the subclavian vein using a venogram based approach, 4 , 5 , 6 , 7 or by an ultrasound based approach for lead insertion 4 , 6 , 7 , 8 or cephalic vein cut down. 4 , 5 , 6 , 7 Most implanters prefer cephalic cutdown as their initial approach. 9 We argue that an ultrasound guided axillary vein approach also should be considered for all such procedures.…”

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confidence: 99%

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Axillary vein access using ultrasound guidance, Venography or Cephalic Cutdown—What is the optimal access technique for insertion of pacing leads?

Davis

Chik

Kumar

et al. 2021

Journal of Arrhythmia

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Cardiac Implantable Electronic Device implantation is associated with a small risk for pocket hematoma partially due to inadvertent axillary/subclavian artery puncture, pneumothorax and infection and more rarely thoracic duct injury and brachial plexus injury and in the long term lead fracture. 1 The traditional anatomic based approach for subclavian vein puncture is particularly associated with an increased risk. 2,3 These risks could be reduced by accessing the axillary vein and not the subclavian vein using a venogram based approach, [4][5][6][7] or by an ultrasound based approach for lead insertion 4,[6][7][8] or cephalic vein cut down. [4][5][6][7] Most implanters prefer cephalic cutdown as their initial approach. 9 We argue that an ultrasound guided axillary vein approach also should be considered for all such procedures. | CEPHALI C VEIN CUTDOWNCephalic cutdown has been suggested to be the preferred venous access to reduce the risk for lead crush and to avoid needle stick injury to surrounding structures. 10 However it is only suitable for some patients 11 due to small vein size, tortuosity, difficulty surgically isolating the vein and in some cases vein absence. 10 It is approached with surgical dissection of the deltopectoral groove, the vein lying between the pectoralis major and deltoid muscles (Figure 1). The vein is blunt dissected free from the surrounding structures and cannulated either with an intravenous (IV) cannula and glidewire or venotomy, a vein pick and then passage of a wire or lead down the vein lumen. In some cases, venography also is

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Contrast venography vs. microwire assisted axillary venipuncture for cardiovascular implantable electronic device implantation

Abstract: Microwire assisted technique is a simple, quicker, safer and more efficacious alternative to contrast venography guided axillary venipuncture.

Cited by 11 publications

References 20 publications

Caudal fluoroscopic guidance for the insertion of transvenous pacing leads

Caudal fluoroscopic guidance for the insertion of transvenous pacing leads

Efficacy and safety of axillary vein puncture real-time guided by roadmap fluoroscopy in cardiac pacemaker implantation

Axillary vein access using ultrasound guidance, Venography or Cephalic Cutdown—What is the optimal access technique for insertion of pacing leads?

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