De Rosa F, Talarico A, Mancuso P, Plastina F
Cardiology Department, Ospedali Riuniti, Cosenza.
G Ital Cardiol. 1998 Oct;28(10):1094-8.
This study was designed to assess the feasibility of percutaneous incannulation of cephalic vein for the implantation of pacemaker and defibrillator leads.
The development of the subclavian vein puncture technique for pacemaker lead implantation has many advantages compared to surgical isolation of cephalic vein. However, initial enthusiasm has been dampened by reports of serious complications because of the anatomical relationships of the subclavian vein.
Percutaneous incannulation of the right cephalic vein was attempted in 75 patients who were candidates for permanent pacemaker or ICD implantation. The technique was effective in 46 patients. It was shown to be ineffective in 18, despite the presence of a normal vein. In seven patients, the cephalic vein was found to be unusable for passing the electrocatheter and in four patients, the vein was absent. In the patients in whom the vein was present, the success rate was 46/71 (64%). The average implantation time was 7.2 minutes (range 5-10), while the average time for conventional surgical technique was 15.2 minutes (range 14-20) (p < 0.001). All patients remained free from complications during a mean follow-up period of 8.2 months (range 1 to 18).
In our opinion, percutaneous incannulation of cephalic vein could be adopted as the first step in pacemaker or defibrillator implantation procedures, as it shows satisfactory success rates, simplicity of execution and absence of complications. Most importantly, in the event of failure, it does not compromise the use of a conventional technique.
本研究旨在评估经皮穿刺头静脉用于植入起搏器和除颤器导线的可行性。
与头静脉手术分离相比，用于起搏器导线植入的锁骨下静脉穿刺技术有诸多优势。然而，由于锁骨下静脉的解剖关系，严重并发症的报道降低了最初的热情。
对75例适合植入永久性起搏器或植入式心律转复除颤器（ICD）的患者尝试经皮穿刺右头静脉。该技术在46例患者中有效。尽管静脉正常，但在18例患者中显示无效。在7例患者中，发现头静脉无法通过电导管，在4例患者中，该静脉缺如。在静脉存在的患者中，成功率为46/71（64%）。平均植入时间为7.2分钟（范围5 - 10分钟），而传统手术技术的平均时间为15.2分钟（范围14 - 20分钟）（p < 0.001）。在平均8.2个月（范围1至18个月）的随访期内，所有患者均未出现并发症。
我们认为，经皮穿刺头静脉可作为起搏器或除颤器植入手术的第一步，因为它显示出令人满意的成功率、操作简单且无并发症。最重要的是，万一失败，它不会影响传统技术的使用。
