Antonelli Dante, Feldman Alexander, Freedberg Nahum A, Turgeman Yoav
Department of Cardiology, Ha Emek Medical Center, Afula, Israel.
Pacing Clin Electrophysiol. 2013 Sep;36(9):1107-10. doi: 10.1111/pace.12181. Epub 2013 May 28.
Axillary vein puncture has been demonstrated to be an effective method for pacemaker and defibrillator leads implantation, without the complications encountered with the standard intrathoracic approach.
Different techniques have been adopted for the cannulation of the axillary vein. We report our experience using the outer edge of the first rib below the inferior border of the clavicle as fluoroscopic landmark.
A subcutaneous pocket is created 1-cm medially and parallel to the delto-pectoral groove and 2 cm below the clavicle. An 18-gauge needle from the upper border of the pocket is directed perpendicularly to the outer edge of the first rib just below the inferior border of the clavicle. If the vein is not entered, the needle is withdrawn and the puncture is repeated with slight variations of needle direction for a maximum of four to five times, then contrast-guided vein puncture is performed. Upon successful vein puncture, a guidewire is inserted and positioned in the superior vena cava. The remainder of the implantation is carried out in a routine manner.
The axillary vein was successfully cannulated without venography in 172 of 182 consecutive patients (94.5%); the vein could not be found in 10 patients (5.5%): in these patients the vein was successfully cannulated after venography performance. No pneumothorax, hemothorax, or brachial plexus injury occurred.
Our approach of axillary venipunture using fluoroscopic landmark, without contrast venography, is simple, safe, and effective.
腋静脉穿刺已被证明是一种用于植入起搏器和除颤器导线的有效方法，不会出现标准胸腔内入路所遇到的并发症。
已采用不同技术进行腋静脉插管。我们报告了使用锁骨下缘下方第一肋骨外边缘作为透视标志的经验。
在锁骨下方2 cm处、与三角胸沟内侧平行1 cm处创建一个皮下囊袋。从囊袋上缘插入一根18号针，垂直于锁骨下缘下方的第一肋骨外边缘。如果未进入静脉，则拔出针，以略微改变针的方向重复穿刺最多四至五次，然后进行造影剂引导下的静脉穿刺。静脉穿刺成功后，插入导丝并将其置于上腔静脉。其余植入操作按常规方式进行。
182例连续患者中有172例（94.5%）在未进行静脉造影的情况下成功进行了腋静脉插管；10例患者（5.5%）未找到静脉：在这些患者中，静脉造影后成功进行了插管。未发生气胸、血胸或臂丛神经损伤。
我们使用透视标志进行腋静脉穿刺的方法，无需静脉造影，简单、安全且有效。
