Migliore Federico, Siciliano Mariachiara, De Lazzari Manuel, Ferretto Sonia, Valle Chiara Dalla, Zorzi Alessandro, Corrado Domenico, Iliceto Sabino, Bertaglia Emanuele
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via N. Giustiniani 2, 35128, Padova, Italy,
J Interv Card Electrophysiol. 2015 Sep;43(3):263-7. doi: 10.1007/s10840-015-0011-7. Epub 2015 May 9.
Axillary vein puncture is an effective method for pacemaker lead insertion with less complications compared with subclavian vein puncture; however, there are limited data on implantable cardioverter defibrillator (ICD) implantation with this technique. We reported our experience with a blind axillary vein puncture using fluoroscopic landmarks consisting of the outer edge of the first rib and the body surface of the second rib for ICD lead implantation.
The study population included 103 consecutive patients (mean age 59 ± 9 years) referred for ICD implantation using axillary vein puncture without contrast venography. An 18-gauge needle was advanced toward the outer edge of the fist rib below the clavicle or the body surface of the second rib. If the vein was not entered, the needle was withdrawn and the puncture was repeated with slight variations of needle direction for a maximum of four times, then contrast-guided vein puncture was performed.
The total implanted leads were 152 including 103 right ventricular leads, 35 right atrial leads, and 14 left ventricular epicardial leads. Blind axillary vein puncture was successful obtained in 96 (93.2 %) patients. The rate of success was higher using the body surface of the second rib compared with the outer edge of the first rib (88.7 vs. 100 %; p = 0.04).Contrast venography was required in seven (6.8 %) patients because of vein course abnormality (n = 5) or vasospasm (n = 2). No acute complications or device-related complications were recorded during a mean follow-up of 12 ± 5 months.
Axillary vein access using fluoroscopic landmarks, especially the body surface of the second rib, is an effective approach for ICD implantation and offers the potential to avoid complications usually observed with traditional subclavian vein approach.
与锁骨下静脉穿刺相比，腋静脉穿刺是一种用于起搏器导线植入且并发症较少的有效方法；然而，关于使用该技术进行植入式心脏复律除颤器（ICD）植入的数据有限。我们报告了我们使用由第一肋骨外边缘和第二肋骨体表组成的透视标志进行腋静脉盲穿以植入ICD导线的经验。
研究人群包括103例连续接受ICD植入的患者（平均年龄59±9岁），采用腋静脉穿刺且未行静脉造影。将一根18号穿刺针朝锁骨下方第一肋骨的外边缘或第二肋骨的体表推进。如果未进入静脉，则拔出穿刺针，并在穿刺针方向略有变化的情况下重复穿刺，最多重复4次，然后进行造影剂引导下的静脉穿刺。
共植入导线152根，包括103根右心室导线、35根右心房导线和14根左心室心外膜导线。96例（93.2%）患者成功进行了腋静脉盲穿。与第一肋骨外边缘相比，使用第二肋骨体表穿刺的成功率更高（88.7%对100%；p=0.04）。7例（6.8%）患者因静脉走行异常（n=5）或血管痉挛（n=2）需要进行静脉造影。在平均12±5个月的随访期间，未记录到急性并发症或与器械相关的并发症。
使用透视标志，尤其是第二肋骨体表进行腋静脉穿刺，是一种用于ICD植入的有效方法，有可能避免传统锁骨下静脉穿刺方法常见的并发症。
