Vein Management for Cardiac Device Implantation

Al-Hadithi, Ali B.A.K.; H., Duc; Boyle, Noel G.

doi:10.1016/j.ccep.2018.05.003

Cited by 3 publications

(3 citation statements)

References 88 publications

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“…This venous approach is characterized by a higher success rate and greater safety as compared to cephalic vein cutdown and subclavian vein puncture, respectively [19][20][21]. The main advantages of the AV over traditional venous accesses are represented by its linear course and large diameter, enabling Diagnostics 2023, 13, 3274 2 of 14 easy insertion of multiple leads [22]. Moreover, its entirely extrathoracic course enables puncture outside the rib cage, thereby reducing the risk of severe complications associated with central intrathoracic venipuncture [23,24].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Ultrasound-Guided Axillary Vein Puncture under Valsalva Maneuver for Diagnostic and Cardiovascular Interventional Purposes: Pacemaker and Cardioverter-Defibrillator Implantation

Sassone,

Bertagnin,

Virzì

et al. 2023

Diagnostics

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Although ultrasound-guided axillary vein access (USGAVA) has proven to be a highly effective and safe method for cardiac electronic implantable device (CIED) lead placement, the collapsibility of the axillary vein (AV) during tidal breathing can lead to narrowing or complete collapse, posing a challenge for successful vein puncture and cannulation. We investigated the potential of the Valsalva maneuver (Vm) as a facilitating technique for USGAVA in this context. Out of 148 patients undergoing CIED implantation via USGAVA, 41 were asked to perform the Vm, because they were considered unsuitable for venipuncture due to a narrower AV diameter, as assessed by ultrasound (2.7 ± 1.7 mm vs. 9.1 ± 3.3 mm, p < 0.0001). Among them, 37 patients were able to perform the Vm correctly. Overall, the Vm resulted in an average increase in the AV diameter of 4.9 ± 3.4 mm (p < 0.001). USGAVA performed during the Vm was successful in 30 patients (81%), and no Vm-related complications were observed during the 30-day follow-up. In patients with unsuccessful USGAVA, the Vm resulted in a notably smaller increase in AV diameter (0.5 ± 0.3 mm vs. 6.0 ± 2.8 mm, p < 0.0001) compared to patients who achieved successful USGAVA, while performing the Vm. Therefore, the Vm is a feasible maneuver to enhance AV diameter and the success rate of USGAVA in most patients undergoing CIED implantation while maintaining safety.

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Section: Introductionmentioning

confidence: 99%

Feasibility of Ultrasound-Guided Axillary Vein Puncture under Valsalva Maneuver for Diagnostic and Cardiovascular Interventional Purposes: Pacemaker and Cardioverter-Defibrillator Implantation

Sassone,

Bertagnin,

Virzì

et al. 2023

Diagnostics

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“… 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.…”

mentioning

confidence: 99%

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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Axillary vein access for antiarrhythmic cardiac device implantation: a literature review

Sassone

Valzania

Laffi

et al. 2020

Journal of Cardiovascular Medicine

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The current narrative review provides an update of available knowledge on venous access techniques for cardiac implantable electronic device implantation, with a focus on axillary vein puncture. Lower procedure-related and lead-related complications have been reported with extrathoracic vein puncture techniques compared with intrathoracic accesses. In particular, extrathoracic lead access through the axillary vein seems to be associated with lower complication incidence than subclavian vein puncture and higher success rate than cephalic vein cutdown. In literature, many techniques have been described for axillary vein access. The use of contrast venography-guided puncture has facilitated the diffusion of the axillary vein approach for device implantation. Venography may be particularly useful in specific demographic and clinical device implantation contexts. Ultrasound-guided or microwire-guided vascular access for lead positioning can be considered a valid alternative to venography, although current applications for axillary vein puncture need further evaluations.

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Vein Management for Cardiac Device Implantation

Cited by 3 publications

References 88 publications

Feasibility of Ultrasound-Guided Axillary Vein Puncture under Valsalva Maneuver for Diagnostic and Cardiovascular Interventional Purposes: Pacemaker and Cardioverter-Defibrillator Implantation

Feasibility of Ultrasound-Guided Axillary Vein Puncture under Valsalva Maneuver for Diagnostic and Cardiovascular Interventional Purposes: Pacemaker and Cardioverter-Defibrillator Implantation

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

Axillary vein access for antiarrhythmic cardiac device implantation: a literature review

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