Navigation by Parallax in Three‐Dimensional Space During Fluoroscopy: Application in Guide Wire‐Directed Axillary/Subclavian Vein Puncture

Abstract

The new technique was effective, efficient, and safe when implemented in clinical practice, justifying the parallax principles on which it is based. The parallax principles may be applied to other invasive medical procedures with due modifications.

First rib and venous anomalies – Anatomical challenges for transvenous implantation of cardiac electronic devices

“…The right axillary vein was identified with retrograde venography (Fig. 2a) and successfully punctured using a guide wire to mark its location fluoroscopically [7]. The right first rib body was also incidentally noticed to be absent and the most cranial rib body belonged to the right second rib.…”

Axillary/Subclavian Vein Puncture Using Navigation by Parallax with an Imaginary Target

“…A corollary to the parallax principles 1 is that the relative positions (or order) of two objects in the two dimensional image will change when the image receiver sweeps past their line of alignment in three dimensional space, as the object nearer the image receiver will deviate with respect to the farther object in a direction opposite to that the image receiver deviates with respect to their line of alignment. This can be easily appreciated by performing a simple experiment (Fig.…”

“…(The parallax principles are clearly defined and described in detail in Ref. 1.) The parallax principles can be used to reliably navigate an object to a target in three dimensional space when only two dimensional images are available for guidance: the object is first aligned with the target in the two dimensional image and then moved along the line of alignment towards or away from the image receiver according to its relative position with respect to the target as revealed by the parallax principles when the image receiver swings from side to side, until the parallax effect is no longer observed and the object hits the target 1 .…”

“…The parallax principles can be used to reliably navigate an object to a target in three dimensional space when only two dimensional images are available for guidance: the object is first aligned with the target in the two dimensional image and then moved along the line of alignment towards or away from the image receiver according to its relative position with respect to the target as revealed by the parallax principles when the image receiver swings from side to side, until the parallax effect is no longer observed and the object hits the target 1 . Navigation by parallax forms the basis of a technique of guide wire‐directed axillary/subclavian vein puncture by fluoroscopy 1 . Even though the technique excels in reliability (it should always be possible to hit the target vein) and safety (minimization of inadvertent damage to adjacent structures), it requires an extra step of placing a guide wire inside the vein to mark its position on fluoroscopy.…”

“…Towards the external border of the middle part of the first rib, the clavicle and the first rib are more separated, improving access to the axillary/subclavian vein. Navigation by parallax 1 can be used to direct puncture of the vein by placing an imaginary target just cranial and lateral to the middle part of the first rib. The needle is first inserted into the body such that its tip is just superficial to the first rib, and then tilted and advanced/withdrawn as necessary to move the tip parallel to the plane of the first rib until venous blood is aspirated.…”