title: Prospective study of axillary vein puncture with or without contrast venography for pacemaker and defibrillator lead implantation.
abstract: Axillary vein puncture may be used to implant pacemaker (PM) or cardioverter defibrillator leads, though usually requires venography. We prospectively compared punctures guided by venography versus a new radiological landmark. In 232 patients, the puncture was guided by injecting diluted contrast material via an ipsilateral peripheral vein (group A, n = 142), or without venography using the intersection of the lateral borders of the second and third rib as a radiological landmark, followed by contrast injection in case of failure (group B, n = 90). We implantated 1-3 leads per patient. In group A, implantation was successful in 135 patients (95%) and in group B in 55 patients (61%, P < 0.001 vs group A). Subsequent contrast injection allowed successful implantations in 34 of 35 patients, with an success rate of 97% for the overall study population of 224 patients. Venous access was achieved after a mean of 10.4 +/- 3.2 minutes of skin incision in group A versus 9.4 +/- 3.0 minutes in group B (ns). Pneumothorax occurred in two patients (1% overall). Thus non-contrast guided puncture using a new radiological landmark was successful in a majority of patients. This technique may be useful in absence of ipsilateral peripheral vein access, or presence of contrast allergy.
authors.affiliation: Cardiology Service, University Hospitals of Geneva, Geneva, Switzerland. haran.burri@hcuge.ch
authors.forename: Haran
authors.initials: H
authors.lastname: Burri
authors.forename: Henri
authors.initials: H
authors.lastname: Sunthorn
authors.forename: Pierre-André
authors.initials: PA
authors.lastname: Dorsaz
authors.forename: Dipen
authors.initials: D
authors.lastname: Shah
mesh_terms: D000368:Aged; D001367:Axillary Vein; D003287:Contrast Media; D017147:Defibrillators, Implantable; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D010690:Phlebography / Q000379:methods*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D011677:Punctures
chemical_list: D003287:Contrast Media