Puncture of the Axillary Vein for the Implant for Electronic Cardiac Devices

Authors

  • Vagner Rossato Pegoraro
  • Eduardo Rodrigues Bento Costa
  • Luiz Fernando Fagundes Gouvea Filho
  • Beatriz Tose Costa Paiva

Keywords:

Axillary vein puncture, Cephalic vein phlebotomy, Subclavian vein puncture, Complications with pacemaker implantation

Abstract

Introduction: The obtaining of venous access for implantation of implantable electronic cardiac devices (IECDs) has been traditionally made by intrathoracic subclavian vein puncture (SVP) or cephalic vein phlebotomy (CVP). Evidence indicates, however, the increased risk of short-term and long-term complications with SVP due to the fact that it is intrathoracic access and the risk of compression of the electrodes by the costoclavicular ligament, leading to different types of defects. CVP, in turn, has been associated with a failure rate that reaches 45%. Axillary vein puncture (AVP) has been described in the literature and is presented here as an alternative to the two techniques mentioned. Methods: A PubMed survey was conducted on articles that mention the AVP, SVP and CVP techniques and compare them to the immediate, short and long term results and success rates for obtaining venous access. Emphasis was placed on comparisons between the various AVP techniques. Conclusion: The AVP technique for obtaining venous access presents some variations among the different authors. It has CVP-like safety, success rates comparable to those of the subclavian vein, and better medium and long term results for electrode function.

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References

Littleford PO, Parsonnet V, Spector SD. Method for the rapid and atraumatic insertion of permanent endocardial pacemaker electrodes through the subclavian vein. Am J Cardiol. 1979;43(5):980-2. https://doi.org/10.1016/0002-9149(79)90363-1

Bernstein AD, Parsonnet V. Survey of cardiac pacing in the United States in 1989. Am J Cardiol. 1992;69(4):331-8. https://doi.org/10.1016/0002-9149(92)90229-R

Bernstein AD, Parsonnet V. Survey of cardiac pacing and defibrillation in the United States in 1993. Am J Cardiol. 1996;78(2):187-96.

Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009 – A World Society of Arrhythmias project.

Pacing Clin Electrophysiol. 2011;34(8):1013-27. https://doi.org/10.1111/j.1540-8159.2011.03150.x.

Kleemann T, Becker T, Doenges K, Vater M, Senges J, Schneider S, et al. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over

a period of >10 years. Circulation. 2007;115(19):2474-80. https://doi.org/10.1161/CIRCULATIONAHA.106.663807

Dorwarth U, Frey B, Dugas M, Matis T, Fiek M, Schmoeckel M, et al. Transvenous defibrillation leads: high incidence of failure during long-term follow-up. J Cardiovasc

Electrophysiol. 2003;14(1):38-43. https://doi.org/10.1046/j.1540-8167.2003.02305.x

Calkins H, Ramza BM, Brinker J, Atiga W, Donahue K, Nsah E, et al. Prospective randomized comparison of the safety and effectiveness of placement of endocardial pacemaker and defibrillator leads using the extrathoracic subclavian vein

guided by contrast venography versus the cephalic approach. Pacing Clin Electrophysiol. 2001;24(4 Pt 1):456-64.

Jiang M, Mao JL, He B. Clinical definition of the axillary vein and experience with blind axillary puncture. Int J Cardiol. 2012;159(3):243-5. https://doi.org/10.1016/j.ijcard.2012.05.089

Mehrotra S, Rohit MK. Prospective study to develop surface landmarks for blind axillary vein puncture for permanent pacemaker and defibrillator lead implantation and compare it to available contrast venography guided technique. Indian Heart J. 2015;67(2):136-40. https://doi.org/10.1016/j.ihj.2015.04.007

Byrd CL. Clinical experience with the extrathoracic introducer insertion technique. Pacing Clin Electrophysiol. 1993;16(9):1781-4. https://doi.org/10.1111/j.1540-8159.1993.

tb01810.x

Antonelli D, Feldman A, Freedberg NA, Turgeman Y. Axillary vein puncture without contrast venography for pacemaker and defibrillator leads implantation. Pacing Clin

Electrophysiol. 2013;36(9):1107-10. https://doi.org/10.1111/pace.12181

Belott P. How to access the axillary vein. Heart Rhythm. 2006;3(3):366-9. https://doi.org/10.1016/j.hrthm.2005.10.031

Migliore F, Siciliano M, De Lazzari M, Ferretto S, Valle CD, Zorzi A, et al. Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads. J Interv Card Electrophysiol. 2015;43(3):263-7. https://doi.org/10.1007/s10840-015-0011-7

Jiang M, Gong XR, Zhou SH, Pu J, Mao JL, He B. A comparison of steep and shallow needle trajectories in blind axillary vein puncture. Pacing Clin Electrophysiol. 2013;36(9):1150-5. https://doi.org/10.1111/pace.1215

Magney JE, Staplin DH, Flynn DM, Hunter DW. A new approach to percutaneous subclavian venipuncture to avoid lead fracture or central venous catheter occlusion.

Pacing Clin Electrophysiol. 1993;16(11):2133-42. https://doi.org/10.1111/j.1540-8159.1993.tb.01018.x

Gardini A, Benedini G. Blind extrathoracic subclavian venipuncture for pacemaker implant: a 3-year experience in 250 patients. Pacing Clin Electrophysiol. 1998;21(11 Pt

:2304-8.

Imnadze G, Awad K, Wolff E, Amberger J, Franz N, Thale J, et al. A novel method of axillary venipuncture using the cephalic vein as a sole anatomic landmark. The Can

J Cardiol. 2015;31(8):1067-9. https://doi.org/10.1016/j.cjca.2015.02.021

Pittiruti M, Biasucci DG, La Greca A, Pizza A, Scoppettuolo G. How to make the axillary vein larger? Effect of 90 degrees abduction of the arm to facilitate ultrasound-guided axillary vein puncture. J Crit Care. 2016;33:38-41. https://doi.org/10.1016/j.jcrc.2015.12.018

Squara F, Tomi J, Scarlatti D, Theodore G, Moceri P, Ferrari E. Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access. Europace. 2017;19(12):2001-6. https://doi.org/10.1093/europace%2Feuw363

Sharma G, Senguttuvan NB, Thachil A, Leong D, Naik N, Yadav R, et al. A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion. Can J Cardiol. 2012;28(5):542-6. https://doi.org/10.1016/j.cjca.2012.02.019

Holubec T, Ursprung G, Schonrath F, Caliskan E, Steffel J, Falk V, et al. Does implantation technique influence lead failure? Acta Cardiol. 2015;70(5):581-6. https://doi.org/10.2143/

AC.70.5.3110519

Kim KH, Park KM, Nam GB, Kim DK, Oh M, Choi H, et al. Comparison of the axillary venous approach and subclavian venous approach for efficacy of permanent pacemaker

implantation. 8-Year follow-up results. Circulation. 2014;78(4):865-71. https://doi.org/10.1253/circj.CJ-13-0884

Chan NY, Kwong NP, Cheong AP. Venous access and longterm pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and

cephalic cutdown. Europace. 2017;19(7):1193-7. https://doi.org/10.1093/europace/euw147

Jacobs DM, Fink AS, Miller RP, Anderson WR, McVenes RD, Lessar JF, et al. Anatomical and morphological evaluation of pacemaker lead compression. Pacing Clin Electrophysiol. 1993;16(3 Pt 1):434-44.

Ramza BM, Rosenthal L, Hui R, Nsah E, Savader S, Lawrence JH, et al. Safety and effectiveness of placement of pacemaker and defibrillator leads in the axillary vein guided by contrast venography. Am J Cardiol. 1997;80(7):892-6. https://doi.org/10.1016/s0002-9149(97)00542-0

Kirkfeldt RE, Johansen JB, Nohr EA, Moller M, Arnsbo P, Nielsen JC. Pneumothorax in cardiac pacing: a populationbased cohort study of 28,860 Danish patients. Europace.

;14(8):1132-8. https://doi.org/10.1093/europace/eus054

Saad EBFF, Veronese F, Maldonado P, Camanho LE. Uso do acesso venoso axilar para implante de eletrodos de marcapassos e desfibriladores. Relampa. 2006;19(4):259-99.

Orihashi K, Imai K, Sato K, Hamamoto M, Okada K, Sueda T. Extrathoracic subclavian venipuncture under ultrasound guidance. Circ J. 2005;69(9):1111-5. https://doi.org/10.1253/circj.69.1111

Aggarwal RK, Connelly DT, Ray SG, Ball J, Charles RG. Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems. Br Heart J. 1995;73(6):571-5. https://doi.org/10.1136/hrt.73.6.571.

Chauhan A, Grace AA, Newell SA, Stone DL, Shapiro LM, Schofield PM, et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol. 1994;17(11 Pt 2):2012-5.

Marinoni G, Broglia P, Bruno N, Perotti R, Bosatra C, Montemartini C. Percutaneous approach in the use of subclavian vein in pacemaker implantation. Giornale italiano

di cardiologia. 1994;24(6):685-9.

Eberhardt F, Bode F, Bonnemeier H, Boguschewski F, Schlei M, Peters W, et al. Long term complications in single and dual chamber pacing are influenced by surgical experience and patient morbidity. Heart. 2005;91(4):500-6. https://doi.org/10.1136/hrt.2003.025411

Fiorista F, Lazari M, Marzegalli M, Piane C, Cotti R, Casazza F, et al. Use of the subclavian vein for permanent cardiac stimulation. Arch Inst Cardiol Mex. 1986; 56(4):309-13.

Hess DS, Gertz EW, Morady F, Scheinman M, Sudduth BK. Permanent pacemaker implantation in the cardiac catheterization laboratory: the subclavian vein approach.

Cathet Cardiovasc Diagn. 1982;8(5):453-8

Kircanski B, Vasic D, Savic D, Stojanov P. Low incidence of complications after cephalic vein cutdown for pacemaker lead implantation in children weighing less than 10

kilograms: A single-center experience with long-term follow-up. Heart Rhythm. 2015;12(8):1820-6. https://doi.org/10.1016/j.hrthm.2015.04.025

Parsonnet V, Roelke M. The cephalic vein cutdown versus subclavian puncture for pacemaker/ICD lead implantation. Pacing Clin Electrophysiol. 1999;22(5):695-7.

Published

16-10-2019

How to Cite

Pegoraro, V. R. ., Costa, E. R. B. ., Gouvea Filho, L. F. F. ., & Paiva, B. T. C. (2019). Puncture of the Axillary Vein for the Implant for Electronic Cardiac Devices. JOURNAL OF CARDIAC ARRHYTHMIAS, 32(1), 17–24. Retrieved from https://jca.org.br/jca/article/view/10

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Section

Cardiac Pacing

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