Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Departments of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
Cardiology. 2021;146(4):464-468. doi: 10.1159/000515360. Epub 2021 Apr 13.
Axillary venous access is preferred for CIED implantation. The procedure is usually performed under fluoroscopic guidance in anteroposterior (A-P) view. However, there is a lack of perception of depth in this view with a fear of creating complications. Caudal fluoroscopy (adding 30°-35° caudal angulation to A-P projection) has been proposed to circumvent this problem.
The aim of this study was to elucidate the advantages of caudal fluoroscopy using fluoroscopic images, contrast venograms, and CT angiography images of axillary vein.
The fluoroscopic images and contrast venograms obtained in the A-P view were compared with caudal fluoroscopy in patients undergoing CIED implantation at our centre. Also, the CT angiography images of axillary vein were reconstructed to understand the relative anatomy of the vein and the underlying lung parenchyma, simulating these 2 projections.
The CT angiography images, contrast venograms, and fluoroscopic images confirmed that caudal fluoroscopy allows better visualization of the vein in relation to the lung parenchyma and rib cage. Analysis of fluoroscopic images revealed that the bend of the first rib formed a conical prominence in caudal fluoroscopy. This served as an important bony landmark for successful venous access, which was usually obtained while the needle was being directed towards this prominence in caudal fluoroscopy.
The proposed advantages of caudal fluoroscopy for CIED implantation have been elucidated by analysis of CT angiography images, contrast venograms, and fluoroscopic images.
经静脉心脏植入电子设备（CIED）时首选腋静脉入路。该操作通常在前后位（AP）透视下进行。然而，由于缺乏深度感知，术者担心会产生并发症，因此对这种入路的接受程度有限。尾侧透视（在 AP 投影上加 30°-35°尾侧角度）已被提议用于解决这个问题。
本研究旨在通过透视图像、对比静脉造影和腋静脉 CT 血管造影图像来阐明尾侧透视的优势。
我们比较了在中心行 CIED 植入术的患者的 AP 位透视图像和对比静脉造影与尾侧透视的差异。同时，重建了腋静脉 CT 血管造影图像，以了解静脉和肺实质的相对解剖结构，模拟这两种透视角度。
CT 血管造影图像、对比静脉造影和透视图像均证实，尾侧透视可更好地显示静脉与肺实质和肋骨之间的关系。透视图像分析显示，第一肋的弯曲在尾侧透视下形成了一个锥形突起。这是成功进行静脉入路的重要骨性标志，在尾侧透视下，通常是在将针尖指向这个突起时获得静脉入路。
通过对 CT 血管造影图像、对比静脉造影和透视图像的分析，阐明了尾侧透视在 CIED 植入中的优势。
