Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Pacing Clin Electrophysiol. 2021 Apr;44(4):607-613. doi: 10.1111/pace.14200. Epub 2021 Mar 2.
Venous access for cardiac implantable electronic devices (CIED) is commonly performed by cephalic venous cut down, or axillary or subclavian vein puncture. The latter technique carries a risk of complications such as pneumothorax or lead crush. Cephalic venous cut down is free of these complications but often less successful due to technical difficulties. We report a highly successful, simplified cephalic venous access with a modified Seldinger technique.
We prospectively studied 221 patients undergoing de novo implantation of a one, two, or three lead device system performed over a 1-year period at our center, and assessed the efficacy of the cephalic vein access including the number of leads successfully placed for each procedure.
In 83% of patients undergoing CIED implantation, a suitable cephalic vein was present. In respectively 98% and 99% of patients undergoing single- or dual-chamber CIED implantation, lead placement could be performed exclusively via the cephalic vein and in 72% of cardiac resynchronization therapy implants, all three leads were placed via cephalic access.
A novel, technically simple cephalic venous catheterization technique provides high success rates for any CIED lead implantation.
心脏植入式电子设备 (CIED) 的静脉通路通常通过头静脉切开、腋静脉或锁骨下静脉穿刺来实现。后一种技术有气胸或导联挤压等并发症的风险。头静脉切开术没有这些并发症，但由于技术困难，往往不太成功。我们报告了一种非常成功、简化的头静脉入路，采用改良的 Seldinger 技术。
我们前瞻性研究了 221 例在我们中心进行的新植入单、双或三导联设备系统的患者，评估了头静脉通路的效果，包括每个手术中成功放置的导联数量。
在接受 CIED 植入的患者中，83%有合适的头静脉。在接受单腔或双腔 CIED 植入的患者中，分别有 98%和 99%的患者可以通过头静脉单独放置导联，在 72%的心脏再同步治疗植入患者中，所有三个导联都可以通过头静脉通路放置。
一种新颖的、技术上简单的头静脉置管技术，为任何 CIED 导联植入提供了高成功率。
