Ramza B M, Rosenthal L, Hui R, Nsah E, Savader S, Lawrence J H, Tomaselli G, Berger R, Brinker J, Calkins H
Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Am J Cardiol. 1997 Oct 1;80(7):892-6. doi: 10.1016/s0002-9149(97)00542-0.
Despite evidence of an increased incidence of lead fracture, the infraclavicular subclavian approach remains the dominant approach for placement of pacemaker and implantable defibrillator leads. Although this complication can be prevented by lead placement in the cephalic vein or by recently described approaches for lead placement in the axillary vein, these approaches have not gained widespread acceptance. The purpose of this study was to evaluate the safety and efficacy of an alternative technique for lead placement that uses contrast-guided venipuncture of the axillary vein with a 5Fr micropuncture introducer set. A total of 50 patients underwent an attempt at placement of pacemaker or implantable defibrillator leads via the axillary vein using this new technique. Patients were randomized into 2 groups based on whether the initial attempt at axillary vein access was performed medial or lateral to the rib cage margin. Lead placement was successfully accomplished in 49 of the 50 patients using this technique. Initial success was achieved in each of 25 patients randomized to the medial approach compared with 18 of 24 patients randomized to the lateral approach to the axillary vein (75%). In each of the 6 patients in whom the initial technique failed, lead placement was subsequently achieved with the medial approach. In addition to a higher initial success rate, the medial approach was determined to be preferable as evidenced by a shorter lead placement time, a smaller number of contrast injections, and a reduced requirement for additional micropuncture guidewires. There were no major complications associated with either approach. Contrast-guided venipuncture of the axillary vein is a safe and effective approach to placement of endocardial leads.
尽管有证据表明锁骨下骨折的发生率有所增加，但锁骨下途径仍是植入起搏器和植入式除颤器导线的主要方法。虽然通过将导线置于头静脉或最近描述的将导线置于腋静脉的方法可以预防这种并发症，但这些方法尚未得到广泛认可。本研究的目的是评估一种替代导线置入技术的安全性和有效性，该技术使用5Fr微穿刺导入套件在造影剂引导下经腋静脉进行静脉穿刺。共有50例患者尝试使用这种新技术经腋静脉置入起搏器或植入式除颤器导线。根据最初尝试经腋静脉穿刺是在胸廓边缘内侧还是外侧，将患者随机分为两组。使用该技术，50例患者中有49例成功完成了导线置入。随机分配至内侧入路的25例患者均首次成功，而随机分配至腋静脉外侧入路的24例患者中有18例首次成功（75%）。在最初技术失败的6例患者中，每例随后均通过内侧入路成功完成导线置入。除了更高的首次成功率外，内侧入路还被认为更可取，这表现为导线置入时间更短、造影剂注射次数更少以及对额外微穿刺导丝的需求减少。两种入路均未出现重大并发症。在造影剂引导下经腋静脉进行静脉穿刺是一种安全有效的心内膜导线置入方法。
