Ji Bing, Mao Yu, Liu Xue-Bo, Sun Bing, Xie Yuan
Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
BMC Cardiovasc Disord. 2025 Apr 16;25(1):286. doi: 10.1186/s12872-025-04731-7.
The axillary vein approach has emerged as a promising alternative to subclavian venous access for pacemaker implantation, offering potential advantages including reduced infection risk and enhanced procedural success. However, standardized protocols for fluoroscopy-guided axillary vein puncture remain undefined.
This study aimed to (1) evaluate the feasibility of a simplified fluoroscopic technique for axillary vein puncture and (2) establish anatomical and clinical predictors of procedural success.
In this retrospective cohort study, 178 consecutive patients undergoing pacemaker implantation at Shanghai Tongji Hospital (January 2022-December 2023) were stratified by puncture technique: right anterior oblique (RAO) 30°, Caudal 35° (C-arm angled toward feet), and vein-guided fluoroscopy. Demographics (age, sex), comorbidities (chronic obstructive pulmonary disease (COPD), spinal disorders), smoking status, and radiographic parameters (subclavian fat thickness, clavicle-first rib angle) were analyzed.
Axillary vein puncture was successful in 169/178 patients (94.9%) without venography. First-attempt success rates were 75.8% (135/178) for RAO 30° and 79.1% (34/43) for Caudal 35°. Key predictors of success included: Sex-specific anatomy, BMI threshold and Clavicular angx les. There was a significant difference in smoking status, subclavian fat thickness 2 cm below the collarbone between males and females (P < 0.001).ROC analysis identified BMI ≥ 23.84 kg/m² as optimal for success (AUC = 0.64, 95% CI: 0.48-0.83).Frontal clavicle-first rib angle independently predicted RAO 30° success (P = 0.012, OR = 1.08, 95% CI: 1.02-1.15), while RAO clavicle-first rib angle correlated with Caudal 35° success (P = 0.031, OR = 1.05, 95% CI: 1.01-1.09). In this study, the cumulative incidence of procedure-related complications was 1.69%. Severe complications such as pneumothorax or lead dislodgement were not observed, highlighting the safety profile of the intervention.
Successful fluoroscopy-guided axillary vein puncture depends critically on patient-specific anatomical factors, including sex, BMI, clavicle-first rib spatial relationships, and smoking status. Our standardized protocol achieved high success rates (94.9%) without ultrasound assistance, highlighting its utility in resource-limited settings.
腋静脉穿刺法已成为起搏器植入术中锁骨下静脉穿刺的一种有前景的替代方法，具有降低感染风险和提高手术成功率等潜在优势。然而，透视引导下腋静脉穿刺的标准化方案仍未明确。
本研究旨在（1）评估一种简化的透视技术用于腋静脉穿刺的可行性，以及（2）确定手术成功的解剖学和临床预测因素。
在这项回顾性队列研究中，对上海同济大学附属同济医院（2022年1月至2023年12月）连续178例行起搏器植入术的患者，根据穿刺技术进行分层：右前斜位（RAO）30°、尾位35°（C形臂向足部倾斜）和静脉引导透视。分析了人口统计学特征（年龄、性别）、合并症（慢性阻塞性肺疾病（COPD）、脊柱疾病）、吸烟状况和影像学参数（锁骨下脂肪厚度、锁骨-第一肋骨夹角）。
169/178例患者（94.9%）腋静脉穿刺成功，无需静脉造影。RAO 30°的首次穿刺成功率为75.8%（135/178），尾位35°的首次穿刺成功率为79.1%（34/43）。成功的关键预测因素包括：性别特异性解剖结构、BMI阈值和锁骨夹角。男性和女性在吸烟状况、锁骨下方2厘米处的锁骨下脂肪厚度方面存在显著差异（P<0.001）。ROC分析确定BMI≥23.84kg/m²是成功的最佳指标（AUC=0.64，95%CI：0.48-0.83）。额位锁骨-第一肋骨夹角独立预测RAO 30°穿刺成功（P=0.012，OR=1.08，95%CI：1.02-1.15），而RAO锁骨-第一肋骨夹角与尾位35°穿刺成功相关（P=0.031，OR=1.05，95%CI：1.01-1.09）。在本研究中，手术相关并发症的累积发生率为1.69%。未观察到气胸或导线移位等严重并发症，突出了该干预措施的安全性。
透视引导下腋静脉穿刺成功与否关键取决于患者特定的解剖因素，包括性别、BMI、锁骨-第一肋骨空间关系和吸烟状况。我们的标准化方案在无超声辅助的情况下取得了较高的成功率（94.9%），突出了其在资源有限环境中的实用性。
