title: An Initiative Technique to Facilitate Axillary Vein Puncture During CRT Implantation.
abstract: OBJECTIVE
  The aim of the study was to describe a new technique to minimize requirement of contrast and the time to puncture the axillary vein during implantation of cardiac resynchronization therapy (CRT) devices.
  
  
  BACKGROUND
  One of the challenges to the wide applications of CRT has been the technical difficulty encountered while obtaining venous access utilizing axillary venous puncture. This is mainly due to vague anatomical land marks. The axillary vein is the preferred access point because of fewer associated risks and better lead protection in the future.
  
  
  METHODS
  We introduced a 0.035 mm guidewire retrogradely from the femoral vein up to the left axillary vein. A single anteroposterior scene at 7.5 frames/second was captured while the guidewire was in the vein. The scene was kept as a roadmap for the axillary vein puncture during the implantation procedure.
  
  
  RESULTS
  The axillary vein was accessed in all patients (100%) and the time to axillary vein puncture was <1 minute in 36 patients (41%) and between 1-5 minutes in the remaining patients. There were no related vascular complications and no contrast venography was required.
  
  
  CONCLUSIONS
  The use of retrograde axillary vein wiring simplifies axillary venous puncture and minimizes the need for contrast media during CRT device implantation without compromising visualized anatomy.
authors.affiliation: Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia. aafagih@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Fagih
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.forename: Yahya
authors.initials: Y
authors.lastname: Al Hebaishi
authors.forename: A
authors.initials: A
authors.lastname: El Tayeb
authors.forename: K
authors.initials: K
authors.lastname: Dagriri
authors.forename: S
authors.initials: S
authors.lastname: Al Ghamdi
mesh_terms: D000792:Angiography; D001367:Axillary Vein / Q000601:surgery*; D058409:Cardiac Resynchronization Therapy Devices; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D011677:Punctures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome