Al Fagih Ahmed, Ahmed A, Al Hebaishi Yahya, El Tayeb A, Dagriri K, Al Ghamdi S
Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
J Invasive Cardiol. 2015 Jul;27(7):341-3.
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.
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.
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.
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.
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.
本研究旨在描述一种新技术，以减少心脏再同步治疗（CRT）设备植入过程中造影剂的用量以及穿刺腋静脉的时间。
CRT广泛应用面临的挑战之一是在利用腋静脉穿刺获取静脉通路时遇到的技术困难。这主要是由于解剖标志不清晰。腋静脉是首选的穿刺点，因为其相关风险较少且未来对导线的保护更好。
我们从股静脉逆行插入一根0.035毫米的导丝至左腋静脉。当导丝在静脉内时，以每秒7.5帧的速度采集单张前后位影像。该影像在植入过程中作为腋静脉穿刺的路线图。
所有患者（100%）均成功穿刺到腋静脉，36例患者（41%）穿刺腋静脉的时间<1分钟，其余患者穿刺时间在1至5分钟之间。未发生相关血管并发症，且无需进行静脉造影。
逆行腋静脉置线的应用简化了腋静脉穿刺，并且在CRT设备植入过程中减少了造影剂的需求，同时不影响可视化解剖结构。
