How to access the axillary vein

Axillary vein spasm during cardiac implantable electronic device implantation

“…Both techniques, AV/SV puncture and CV cutdown, involve the vascular segments found within the clavipectoral triangle [2,15].…”

“…A vast majority of those are procedures involving transvenous cardiac lead insertion. Currently, there are two main techniques for lead insertion: cephalic vein (CV) cutdown and axillary vein or subclavian vein puncture (AV/SV puncture) [2,5,15].…”

Comparison of the Axillary Venous Approach and Subclavian Venous Approach for Efficacy of Permanent Pacemaker Implantation

“…Further, pneumothorax and subclavian crush syndrome rarely occur with axillary venous access. 1 Various axillary venous approach techniques have been adopted, which consist of a blind percutaneous puncture, a technique using a simple superficial landmark of the first rib or the intersection of the lateral borders of the second and third ribs, and a method using radiographic contrast or ultrasound. 1, 2 Byrd 12,13 first described a technique for cannulating the extrathoracic subclavian vein as it crosses the first rib.…”

Fluoroscopy-Guided Axillary Vein Puncture, a Reliable Method to Prevent Acute Complications Associated With Pacemaker, Defibrillator, and Cardiac Resynchronization Therapy Leads Insertion

“…It is anterior and medial to the axillary artery and brachial plexus and partially overlaps. At the level of the coracoid process, the axillary vein receives the lateral cephalic vein [10]. pulled over to the incision and the first rib is identified.…”

“…If the first pass is unsuccessful the needle and syringe are moved either medially or laterally along the first rib, and the maneuver repeated until the vein is entered. Once the vein is entered the guide wire is passed and the sheath applied per standard technique [10,11].…”