The New Surface Landmarks for Blind Axillary Vein Puncture

Abstract

Objective To compare the efficacy of blind axillary vein puncture utilizing the new surface landmarks for the subclavian method. Methods This prospective and randomized study was performed at two cardiology medical centers in East China. Five hundred thirty-eight patients indicated to undergo left-sided pacemaker or implantable cardioverter defibrillator implantation were enrolled, 272 patients under the axillary access and 266 patients under the subclavian approach. A new superficial landmark was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. We measured lead placement time and X-ray time from vein puncture until all leads were placed in superior vena cava. Meanwhile, the rate of success of lead placement and the type and incidence of complications were compared between the two groups. Results There were no significant differences between the two groups in baseline characteristics or number of leads implanted. There were high success rates for both strategies (98.6% [494/501] vs . 98.4% [479/487], P =0.752) and similar complication rates (14% [38/272] vs . 15% [40/266], P =0.702). Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group. Conclusion We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and also allows to get this vein without the guidance of fluoroscopy, contrast, or echography.

Efficacy and safety of axillary vein puncture real-time guided by roadmap fluoroscopy in cardiac pacemaker implantation

“…The rationale for this study was based on previous literature data demonstrating high success rate of axillary vein puncture as the route for pacemaker lead insertion, mostly from observational studies. [16][17][18] The higher axillary success rate guided by road map fluoroscopy was confirmed in our present observational study. Roadmap imaging also allows the possibility of evaluating vein patency before pocket incision, which is especially useful in special patients who previously had undergone thoracic surgery or radiotherapy.…”

Different venous approaches for implantation of cardiac electronic devices. A network meta‐analysis

“…The initial search yielded 2904 articles, of which 36 21–56 (39,351 patients) were included in the final analysis. The flow of study selection is depicted in Figure 1.…”

A massive hemothorax resulted from injury to the left subclavian artery branch during pacemaker implantation: case report and literature review

“…and give early treatment.Third,an interdisciplinary team should be established according to the ESC guidelines for cardiac pacing and cardiac resynchronization in 2021 [1] ,when hemothorax occurs,the surgeon should be contacted for VATS for diagnosis and treatment of injured vessels. Fourthly, Puncture subclavian venous catheterization is one of the most common iatrogenic hemothorax causes [7] .Axillary venipuncture or cephalic venotomy could reduce postoperative complications [8,9] Fig1 : The pacemaker and Chest computed tomography Fig2 :The video-assisted thoracic surgery…”