A cephalic vein cutdown and venography technique to facilitate pacemaker and defibrillator lead implantation

The aim of this study was to assess the feasibility of a cephalic vein cutdown and venography technique for implantation of a pacemaker or ICD and to determine the causes of failure of cephalic vein cutdown. In consecutive patients who underwent pacemaker or ICD implants, a modified cephalic vein guidewire technique was performed. This technique was attempted in 289 pacemaker implants and 26 ICD implants (155 men, 160 women; mean age 74 +/- 10 years). The success rate for implantation of a single chamber and a dual chamber device by using this technique alone was 84% (54/64) and 74% (185/251), respectively (P = 0.10). In an additional 7% of patients with dual chamber implant, the cephalic vein can be used for passage of the ventricular lead. A cephalic venogram was required in 82 patients and facilitated the passage of the guidewire in 62 (79%) of them. No complication related to vascular access was observed with this technique. This technique failed in 54 (17%) of 315 patients due to (1) failure of cephalic vein isolation (48%), (2) venous stenosis (24%), or (3) venous torturosity or anomalies (28%). There were no significant differences in the patient's age, sex, type of device, and the fluoroscopic time for lead placement between patients with or without successful lead placement using this technique (all P > 0.05). In conclusion, a simple modification of the cephalic vein guidewire technique together with venography has facilitated the placement of leads during pacemaker and ICD implant. This technique is safe and applicable in the majority of patients and avoids the risk of subclavian puncture.