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

Abstract

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.

Predictors of successful ultrasound‐guided lead implantation

“…Many techniques have been utilized for venous access during the placement of cardiac implantable electronic devices (CIEDs) . Over the past several years, practice has shifted from subclavian access to axillary vein access . While advances in sheaths, lead design, and anatomic access site have gradually improved the safety and efficacy of implantation, periprocedural risks and complications persist.…”

Implante de marcapasos en un centro de Uruguay (2010-2019). Seguimiento y análisis

“…Destacamos la baja incidencia de neumotórax como complicación de esta técnica (0,39% de los procedimientos). De cualquier manera, actualmente estamos protocolizando la punción axilar guiada por radioscopia, dados los beneficios potenciales que han sido reportados con esta técnica (12) .…”

Pneumothorax as a complication of cardiac rhythm management devices implantation

“…The third method used for venous access is axillary vein puncture. This approach is not used often due to fear of pneumothorax, but for an experienced operator, who knows the regional anatomy well, this should be the method of choice [11,12,13]. Considering these facts, cephalic vein cut-down is preferred to subclavian or axillary vein puncture as the venous access in most medical centers, but whenever the cephalic vein cannot be found, or it is too small and thin, puncturing of the subclavian or the axillary vein must be done.…”