Subclavian and Axillary Vein Access Versus Cephalic Vein Cutdown for Cardiac Implantable Electronic Device Implantation

Atti, Varunsiri; Turagam, Mohit K.; Garg, Jalaj; Koerber, Scott; Angirekula, Aakash; Gopinathannair, Rakesh; Lakkireddy, Dhanunjaya

doi:10.1016/j.jacep.2020.01.006

Cited by 41 publications

(48 citation statements)

References 38 publications

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“…3 In the same meta-analysis, lead failure in axillary access did not differ from cephalic access. 3 In a large retrospective analysis, lead failure was lower in cephalic access than axillary puncture. 4 Barbhaiya et al show a surprisingly high failure rate when implanting multiple leads.…”

Section: Do Not Yet Abandon Cephalic Vein Access For Multiple Leads Imentioning

confidence: 91%

“…In the recent meta-analysis success rate was 76% and the complication rate was equal to axillary and lower than subclavian access. 3 Analysis of larger numbers of multi-lead cephalic access in a multicentre setting is needed before we can conclude that the lead failure rate is truly higher. However, as the success rate of cephalic cutdown is only 55%-80%, operators are certainly required to be proficient in a different puncture technique, preferably axillary vein access.…”

Section: Do Not Yet Abandon Cephalic Vein Access For Multiple Leads Imentioning

confidence: 99%

“…Cephalic access is considered superior to subclavian because of the lower risk of subclavian crush syndrome. A recent meta‐analysis demonstrated more lead failure in subclavian versus cephalic vein access 3 . In the same meta‐analysis, lead failure in axillary access did not differ from cephalic access 3 .…”

mentioning

confidence: 91%

“…A recent meta‐analysis demonstrated more lead failure in subclavian versus cephalic vein access 3 . In the same meta‐analysis, lead failure in axillary access did not differ from cephalic access 3 . In a large retrospective analysis, lead failure was lower in cephalic access than axillary puncture 4 …”

mentioning

confidence: 98%

“…We think it is too early to abandon cephalic vein access even for multiple leads. In the recent meta‐analysis success rate was 76% and the complication rate was equal to axillary and lower than subclavian access 3 . Analysis of larger numbers of multi‐lead cephalic access in a multicentre setting is needed before we can conclude that the lead failure rate is truly higher.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Do not yet abandon cephalic vein access for multiple leads in ICD implantation

Maass

Groenveld

Rienstra

2020

Cardiovasc electrophysiol

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Section: Do Not Yet Abandon Cephalic Vein Access For Multiple Leads Imentioning

confidence: 91%

Section: Do Not Yet Abandon Cephalic Vein Access For Multiple Leads Imentioning

confidence: 99%

mentioning

confidence: 91%

mentioning

confidence: 98%

mentioning

confidence: 99%

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Do not yet abandon cephalic vein access for multiple leads in ICD implantation

Maass

Groenveld

Rienstra

2020

Cardiovasc electrophysiol

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Axillary and subclavian venous spasm during pacemaker implantation – A case report and literature review

Venet,

Vergier,

Cenac

et al. 2024

Clinical Case Reports

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Key Clinical MessageVenous spasm is an important reason for complicated or failed implantations of cardiac implantable electronic devices. Prevention or risk reduction of venous spasm during cardiac implantable electronic device implantation may be achieved by ultrasound or fluoroscopic imaging prior to puncture, cephalic vein cut‐down, sufficient pre‐ and perioperative hydration, nitroglycerin injection and effective sedation, and analgesia.AbstractThis case report with literature review focuses on venous spasm as a potential cause for complicated implantations of cardiac implantable electronic devices. The case report is clinically relevant as it describes a progressive spasm affecting the axillary and the subclavian vein. A 66‐year‐old female complained of symptomatic atrial fibrillation (AF) and atypical atrial flutter despite interventional and medical treatment. As an ultimate treatment, she was scheduled for pacemaker implantation and atrioventricular node ablation. Several puncture attempts of the axillary vein failed. Despite venous blood aspiration, no guidewires could be advanced into the axillary vein. We performed a first venogram revealing significant spasm of the axillary vein. Another failed venous puncture occurred after change of access site to the subclavian vein. A second venogram displayed progression of the spasm, now affecting both the axillary and the subclavian veins. Normal saline perfusion was administered as well as intravenous isosorbide. Unfortunately, a repeated venogram after 15 min waiting time showed persistence of the spasm, still affecting both veins. The procedure was discontinued as the patient became uncomfortable. Venous spasm is an important reason for complicated or failed implantations of cardiac implantable electronic devices. Commonly used medical prevention and treatment are intravenous fluids and nitroglycerin. Prevention or risk reduction of venous spasm during cardiac implantable electronic device implantation may be achieved by ultrasound or fluoroscopic imaging prior to puncture, cephalic vein cut‐down, sufficient pre‐ and perioperative hydration, nitroglycerin injection and effective sedation and analgesia.

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Safety and Efficiency of Cephalic Vein Puncture by Modified Seldinger Technique Compared to Subclavian Vein Puncture for Cardiac Implantable Electronic Devices

Weidauer,

Knüpfer,

Lottermoser

et al. 2024

Clinical Cardiology

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IntroductionThe establishment of venous access is one of the driving factors for complications during implantation of pacemakers and defibrillators (cardiac implantable electronic devices [CIED]). Recently, a novel approach of accessing the cephalic vein for CIED by cephalic vein puncture (CVP) using a modified Seldinger technique has been described, promising high success rates and simplified handling with steeper learning curves. In this single‐center registry, we analyzed the safety and efficiency of CVP to SVP access after defining CVP as the primary access route in our center.MethodsA total of 229 consecutive patients receiving a CIED were included in the registry. Sixty‐one patients were implanted by primary or bail‐out SVP; 168 patients received primary cephalic preparation and CVP was performed when possible, using a hydrophilic transradial sheath.ResultsImplantation of at least one lead via CVP was successful in 151 of 168 patients (90%), and implantation of all leads was possible in 122 of 168 patients (72.6%). Total implantation times and fluoroscopy times and doses did not differ between CVP and SVP implantations. Pneumothorax occurred in 0/122 patients implanted via CVP alone, but 8/107 (7.5%) patients received at least one lead via SVP.ConclusionOur data confirms high success rates of the CVP for CIED implantation. Moreover, this method can be used without significantly prolonging the total procedure time or applying fluoroscopy dose compared to the highly efficient SVP while showing lower overall complication rates.

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Subclavian and Axillary Vein Access Versus Cephalic Vein Cutdown for Cardiac Implantable Electronic Device Implantation

Cited by 41 publications

References 38 publications

Do not yet abandon cephalic vein access for multiple leads in ICD implantation

Do not yet abandon cephalic vein access for multiple leads in ICD implantation

Axillary and subclavian venous spasm during pacemaker implantation – A case report and literature review

Safety and Efficiency of Cephalic Vein Puncture by Modified Seldinger Technique Compared to Subclavian Vein Puncture for Cardiac Implantable Electronic Devices

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