Wang Xiaxia, Zhang Yongtao, Zhang Yingying
The Affiliated Hospital of Qingdao University, Department of Cardiology, Qingdao University, 266003, Qingdao, China.
The Affiliated Hospital of Qingdao University, Department of Cardiology, Qingdao University, 266003, Qingdao, China.
Indian Pacing Electrophysiol J. 2022 Sep-Oct;22(5):231-234. doi: 10.1016/j.ipej.2022.07.009. Epub 2022 Aug 1.
Axillary vein puncture is a popular puncture site for pacemaker implantation. However, due to the lacking of body surface markers, the current puncture method is too complicated and affect the popularization and application of axillary vein puncture. Here, we performed a new body surface landmark to make the blind axillary vein puncture simple and easy.
The study population included 30 patients referred for pacemaker implantation using axillary vein puncture. Digital subtraction angiography (DSA) was used to determine the direction and the surface landmarks of the axillary vein. Medial cusp of thoracic triangle and the coracoid process were directly touched with fingers. The puncture point was about 1 cm below the coracoid, and the needle tip pointed to the medial cusp of thoracic triangle with the angle of 30-60°.
There was little variation in distribution of axillary vein. The body surface landmark of the junction of the axillary vein and the subclavian vein is on the medial cusp of thoracic triangle. In these 30 patients, blind axillary vein puncture was successful obtained in all patients. There was no pneumothorax and inadvertent arterial puncture. The pacemaker lead wire was placed smoothly. Moreover, the pacemaker pocket was ideally positioned when cut along the puncture point.
Blind axillary vein access using the body surface landmark of the thoracic triangle is an effective method for pacemaker implantation and can obvious avoid the complications usually observed with the traditional subclavian vein approach.
腋静脉穿刺是起搏器植入常用的穿刺部位。然而，由于缺乏体表标志，目前的穿刺方法过于复杂，影响了腋静脉穿刺的推广应用。在此，我们提出一种新的体表标志，以使盲穿腋静脉变得简单易行。
研究对象包括30例行腋静脉穿刺起搏器植入术的患者。采用数字减影血管造影（DSA）确定腋静脉的走行方向和体表标志。用手指直接触摸胸三角内侧尖和喙突。穿刺点位于喙突下方约1 cm处，针尖指向胸三角内侧尖，角度为30 - 60°。
腋静脉走行分布变异较小。腋静脉与锁骨下静脉交汇处的体表标志位于胸三角内侧尖。这30例患者均成功进行了盲穿腋静脉穿刺。无气胸及误穿动脉情况。起搏器导线顺利置入。此外，沿穿刺点切开时，起搏器囊袋位置理想。
利用胸三角体表标志进行盲穿腋静脉是一种有效的起搏器植入方法，可明显避免传统锁骨下静脉穿刺方法常见的并发症。
