Smith D E, Doherty T M, Reynolds G T, Young E K, Skinner A R, French W J
Department of Medicine, Saint John's Cardiovascular Research Center, Harbor-UCLA Medical Center, Torrance 90502, USA.
Cathet Cardiovasc Diagn. 1996 Mar;37(3):252-7. doi: 10.1002/(SICI)1097-0304(199603)37:3<252::AID-CCD5>3.0.CO;2-B.
Digital cinefluoroscopic venography of the subclavian vein was performed in 26 consecutive patients. The optimal stored image of the anticipated venipuncture site was magnified, road mapped, and used to compare with fluoroscopic-guided venipuncture. Two anatomic subtypes for both subclavian veins were observed. For the left subclavian vein, a gradual curve was seen most often (57%), while the remainder (43%) exhibited an "s"-shaped curve. For the right subclavian, a gradual curve was observed most frequently (60%) while an acute 90 degrees angle was noted in the remainder (40%). The "s"-shaped curve in the left subclavian vein necessitated redirection of the needle site both laterally and cranially. In three or 12% of patients venography showed either subclavian thrombosis or a persistent left superior vena cava and lead insertion was moved to the opposite side. Successful venipuncture and subsequent cannulation of the subclavian vein was achieved with the first or second passage of the needle in 22 or 85% of the 26 patients. Digital cinefluoroscopic venography appears to be both safe and rapid and may facilitate insertion of permanent pacemaker leads into the subclavian vein.
对26例连续患者进行了锁骨下静脉数字电影荧光静脉造影。将预期静脉穿刺部位的最佳存储图像进行放大、路径图绘制，并用于与透视引导下的静脉穿刺进行比较。观察到两侧锁骨下静脉有两种解剖亚型。对于左锁骨下静脉，最常见的是逐渐弯曲（57%），而其余（43%）表现为“s”形弯曲。对于右锁骨下静脉，最常观察到逐渐弯曲（60%），而其余（40%）则呈现90度锐角。左锁骨下静脉的“s”形弯曲需要将针的穿刺部位向外侧和头侧重新定位。在3例（12%）患者中，静脉造影显示锁骨下血栓形成或永存左上腔静脉，导线插入部位移至对侧。26例患者中有22例（85%）在针的第一次或第二次穿刺时成功进行了静脉穿刺并随后成功插入锁骨下静脉。数字电影荧光静脉造影似乎既安全又快速，可能有助于将永久性起搏器导线插入锁骨下静脉。
