A Cephalic Vein Cutdown and Venography Technique to Facilitate Pacemaker and Defibrillator Lead Implantation

Abstract

The aim of this study was to assess the feasibility of a cephalic vein cutdown and venography technique for implantation of a pacemaker or ICD and to determine the causes of failure of cephalic vein cutdown. In consecutive patients who underwent pacemaker or ICD implants, a modified cephalic vein guidewire technique was performed. This technique was attempted in 289 pacemaker implants and 26 ICD implants (155 men, 160 women; mean age 74 +/- 10 years). The success rate for implantation of a single chamber and a dual chamber device by using this technique alone was 84% (54/64) and 74% (185/251), respectively (P = 0.10). In an additional 7% of patients with dual chamber implant, the cephalic vein can be used for passage of the ventricular lead. A cephalic venogram was required in 82 patients and facilitated the passage of the guidewire in 62 (79%) of them. No complication related to vascular access was observed with this technique. This technique failed in 54 (17%) of 315 patients due to (1) failure of cephalic vein isolation (48%), (2) venous stenosis (24%), or (3) venous torturosity or anomalies (28%). There were no significant differences in the patient's age, sex, type of device, and the fluoroscopic time for lead placement between patients with or without successful lead placement using this technique (all P > 0.05). In conclusion, a simple modification of the cephalic vein guidewire technique together with venography has facilitated the placement of leads during pacemaker and ICD implant. This technique is safe and applicable in the majority of patients and avoids the risk of subclavian puncture.

Clinical implications of cephalic vein morphometry in routine cardiac implantable electronic device insertion

“…However, the failure rate also depends on the number and structure of the leads introduced via the CV, vessel wall elasticity, operator's experience, etc. [2,8,12,14]. Moreover, we found no CVs with a diameter of over 1.0 cm, with the mean values of CV diameter consequently lower [6].…”

“…Visual inspection of the vessel is limited only to the segment exposed during the procedure, with further segments of the vessel visualised with contrast imaging [5,11]. Venography is still the only assessment that can be conducted during the procedure to help the operator decide whether or not to use the given vessel [13,14].…”

Selected clinical challenges of a supraclavicular cephalic vein in cardiac implantable electronic device implantation

“…The presence and nature of any individual variations in the morphological structure and anatomical position of vessels can be detected practically only during intraprocedural venography, in the cases of lead advancement difficulties [11,12]. The purpose of this study was to use venographic images to assess the rate and nature of two CV variations (a supraclavicular CV and a supraclavicular persistent JCV) as well as their effect on the course of CIED implantation procedures.…”

Unusual Terminations of the External Jugular Vein and Cephalic Vein: Case Report

“…1,4,6.11.12 Separately, it is the most appropriate vessel utilized in cephalic vein pacemaker and defibrillator implantations and in urgent intravenous drug injections, and the its possibility to get injured is rather low compared to the other veins. 1,4,6,11,12 Besides, having the knowledge of the variations of the termination and the course of these veins is quite important for surgeons, radiologists, anesthetists and cosmetic surgeons. 1,4,6,[13][14][15] Consequently, we are of the opinion that it would be of great use to the surgeons, radiologists and anesthetists involved in this region (of the body) to have the knowledge of the variations we have described as to external jugular vein and cephalic vein.…”