Cephalic vein access has significant advantages over the traditional use of the subclavian and axillary veins in patients who undergo permanent pacemaker and implantable defibrillator placement. Both long and short term risk reduction occurs in forgoing the traditional approaches since pneumothorax, an unfortunate short term consequence, is eliminated. Additionally, subclavian crush syndrome, a common long term complication, is avoided by using the cephalic vein. The cephalic approach has been thought to be a more difficult technique than traditional approaches, elongating the procedure time for “cut-down.” The purpose of study is to demonstrate the that the use of innovative techniques allows both easier access and a higher yield offering greater safety to patients.
Standard cephalic, subclavian, and axillary approaches were used under fluoroscopic guidance during implantation.
A total of 583 consecutive patients who were scheduled for implantation of a permanent pacemaker or implantible defibrillator (ICD), were prospectively enrolled. Patient mean age was 74.3 years (range: 27 – 100) and 62% were male. Sixty-five percent (n= 379) were candidates for permanent pacemaker implantation and 35% (n=204) required implantable defibrillator placement. The standard 0.38 “width J-wire, which is provided by most commercially available sheath introducers, provided successful cephalic vein access in 60% of cases. However, upon use of the more flexible ”Glidewire“ for tortuous, smaller sized, and diseased veins, access increased by 26%, allowing a total success rate of cephalic vein access of 86%.
Successful cephalic vein access yield during implant procedures was significantly improved from 60% to 86%.
Using the innovative maneuvers described provide greater safety, and more advantageous outcomes to patients undergoing permanent pacemaker and implantable defibrillator placement.
S.E. Dodd, None.