Doppler Guided Extrathoracic Introducer Insertion

Abstract

Recent reports have raised concern over the use of standard subclavian puncture for placement of permanent pacing leads. This study reports the initial experience of one implanter in 59 consecutive, unselected patients undergoing implantation of a variety of pacing leads in whom a simple Doppler flow detector was used to guide extrathoracic venipuncture of the lateral subclavian/axillary vein. A total of 100 leads were placed for 48 right- and 11 left-sided systems. Lead insertion by this technique was successful in all patients. One small pneumothorax and two uncomplicated arterial punctures occurred. One patient's leads were revised electively because of unacceptable loss of redundancy when standing. There have been no infections or other late complications. A simple Doppler flow detector appears to be useful in identifying the lateral subclavian/axillary vein for extrathoracic pacemaker lead placement.

Ultrasound‐Guided Venous Access for Permanent Pacemaker Leads

“…The ultrasound approach resulted in more back‐bleeding and significantly greater use of pressure dressings, but fortunately pocket hematomas were not more frequent. This increased back‐bleeding has been noted in other reports and attributed to less overlying tissue when compared with the standard subclavian site 10 . It is conceivable that the larger venotomy made by the retained guidewire technique contributed to back‐bleeding, but pressure dressings were not more common in two‐lead implants (48%) when compared with single‐lead implants (41%, P = 0.42) and the three pocket hematomas all occurred in single‐lead implants, where no guidewire was retained.…”

Extrathoracic Subclavian Venipuncture Under Ultrasound Guidance

“…[1][2][3][4][5][6][7] However, the occurrence of pneumothorax or arterial injury was not completely avoided, for reasons that are not entirely clear. Thus, the purpose of this study was to examine the feasibility, safety, and efficacy of US-guided extrathoracic subclavian venipuncture, as well as elucidating the mechanism of the complications and the problems that need to be solved to improve outcomes in the future.…”

Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation

“…Fyke 69 has described use of an extrathoracic introducer insertion technique in 59 consecutive patients (total of 100 leads) with a simple Doppler flow detector. A sterile Doppler flow detector is moved along the clavicle.…”