title: A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion.
abstract: BACKGROUND
  The intrathoracic subclavian venous technique for pacemaker implantation may be associated with serious complications. We describe an alternative technique for obtaining venous access for pacemaker implantation through axillary vein under fluoroscopic guidance and compare it with the conventional, subclavian approach.
  
  
  METHODS
  We conducted a single-centre, prospective, nonrandomized study. All adult patients with indication for permanent pacing who consented were recruited during a 3-year period. To access the axillary vein, we used the alternative technique with a new fluoroscopic landmark. The subclavian access was obtained as per the usual approach.
  
  
  RESULTS
  We studied 478 lead placements during 3 years; 315 lead placements through axillary venous technique (group 1) were compared with 163 lead placements through subclavian venous technique (group 2). Both routes had a high and comparable success rate, 98.09% in group 1 and 96.93% in group 2. The axillary approach was successful at the first attempt in 194 punctures (61.6%), as vs 60 in group 2 (36.8%) P < 0.0001. The average number of attempts in group 1 was 2.06 per patient and 2.56 in group 2 (P < 0.001). There were 3 (2.94%) pneumothoraxes in group 2 and none in group 1. During a mean follow-up period of 3.2 months in group1 and 3.7 months in group 2, 1 patient in group 2 had a lead fracture.
  
  
  CONCLUSIONS
  The fluoroscopically guided axillary venous approach for implanting permanent pacemakers is equivalent to the traditional anatomic landmark-guided intrathoracic subclavian approach and has fewer complications and shorter procedural time to access the vein.
authors.affiliation: Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. drsharmagautam@gmail.com
authors.forename: Gautam
authors.initials: G
authors.lastname: Sharma
authors.forename: Nagendra Boopathy
authors.initials: NB
authors.lastname: Senguttuvan
authors.forename: Ajit
authors.initials: A
authors.lastname: Thachil
authors.forename: Darryl
authors.initials: D
authors.lastname: Leong
authors.forename: Nitish
authors.initials: N
authors.lastname: Naik
authors.forename: Rakesh
authors.initials: R
authors.lastname: Yadav
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Bahl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D001367:Axillary Vein / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D004567:Electrodes, Implanted; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D061214:Patient Safety; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult