title: Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown.
abstract: OBJECTIVE
  Existing data on the relationship between venous access and long-term pacemaker lead failure (PLF) are scarce and inconsistent. We aim to study the hypothesis that contrast-guided axillary vein puncture (AP) is better than subclavian puncture (SP) and similar to cephalic vein cutdown (CV) in the incidence of PLF and the success rate of AP is higher than CV.
  
  
  RESULTS
  The case records of 409 patients with 681 implantable pacemaker leads were reviewed. Two hundred and fifty-two, 217, and 212 leads were implanted via AP, CV, and SP, respectively. With a mean follow-up of 73.6 ± 33.1 months, 20 (2.9%) PLF occurred. Three (1.2%), 5 (2.3%), and 12 (5.6%) PLF occurred in the AP, CV, and SP groups, respectively. On multivariate Cox regression analysis, the only independent predictor for PLF was the use of SP instead of AP (AP vs. SP; hazard ratio: 0.261; 95% confidence interval: 0.071-0.954, P = 0.042). The success rate of CV (78.2%) was significantly lower than those of AP (97.6%) and SP (96.8%) (P < 0.001).
  
  
  CONCLUSIONS
  Compared with SP, the use of AP but not CV independently predicted a lower risk of PLF. The success rates in achieving venous accesses were similar between AP and SP, but significantly lower for CV. Axillary vein puncture may thus be considered the venous access of choice for pacemaker lead implantation.
authors.affiliation: Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong, People's Republic of China.
authors.forename: Ngai-Yin
authors.initials: NY
authors.lastname: Chan
authors.affiliation: Yan Chai Hospital, Hong Kong, People's Republic of China.
authors.forename: Nim-Pong
authors.initials: NP
authors.lastname: Kwong
authors.affiliation: Alice Ho Miu Ling Nethersole Hospital, Hong Kong, People's Republic of China.
authors.forename: Adrian-Piers
authors.initials: AP
authors.lastname: Cheong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001367:Axillary Vein / Q000000981:diagnostic imaging*; D002304:Cardiac Pacing, Artificial; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage*; D004868:Equipment Failure; D005260:Female; D006723:Hong Kong; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D010690:Phlebography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D013997:Time Factors; D016896:Treatment Outcome; D016748:Venous Cutdown / Q000009:adverse effects / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Axillary vein puncture; Cephalic vein cutdown; Lead failure; Pacemaker; Subclavian crush; Subclavian vein puncture