Arterial trauma during ultrasound-guided axillary vein puncture for endocardial lead placement

Abstract

The axillary vein is an accepted route for gaining central venous access, particularly for pacing and implantable cardioverter defibrillator leads, with ultrasound guidance a useful way of facilitating venous puncture. We report a series of cases demonstrating the important complication of inadvertent arterial injury with this technique.

Percutaneous Axillary Vein Approach in Pediatric Pacing: Comparison with Subclavian Vein Approach

“…Complication rate in adult series was low, hemo/pneumothorax (0–1%), inadvertent arterial puncture (8%), subclavian vein thrombosis (0%) . Axillary artery trauma was also described with ultrasound‐guided puncture . However, local arterial bleeding, either caused by the direct puncture of the axillary artery or by laceration of small arterial branches, can be controlled more easily with manual pressure than after inadvertent infraclavicular subclavian artery puncture.…”

Ultrasound-guided infraclavicular axillary vein cannulation: a useful alternative to the internal jugular vein

“…Moreover, the complex anatomy of the axillary artery and the thoracoacromial arterial trunk may mean that arterial punctures that go unrecognized during successful venous cannulation, a phenomenon reported during pacemaker placement. 24 Pneumothorax is a recognized and worrying complication of landmark SCV cannulation. We observed one case where a pneumothorax was visible on the immediate post-procedural chest radiograph and one case where a pleural collection was aspirated and which the operator felt would have resulted in a pneumothorax had the fluid not been present.…”

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

“…To our knowledge, roadmap fluoroscopy has never previously been evaluated for use in cardiac pacemaker implantation. [9][10][11]…”