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Pre-procedure duplex ultrasonography to assist cephalic vein isolation in pacemaker and defibrillator implantation
Jan-Yow Chen1, Kuan-Cheng Chang, Yu-Chin Lin
1Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Insights
Pre-procedural duplex ultrasonography significantly improves cephalic vein isolation for pacemaker and defibrillator implantation. This imaging technique offers superior surface localization compared to traditional methods, enhancing procedural success rates.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Cardiology
Background:
- Cephalic vein isolation is critical for pacemaker and defibrillator implantation.
- The traditional deltopectoral groove landmark often leads to difficulties and failed procedures.
- Pre-procedural duplex ultrasonography was evaluated to improve cephalic vein localization.
Purpose of the Study:
- To assess the efficacy of pre-procedural duplex ultrasonography in isolating the cephalic vein.
- To compare the accuracy of sonographic localization with the deltopectoral groove method.
- To investigate the relationship between cephalic vein depth and patient body parameters.
Main Methods:
- 80 patients undergoing pacemaker or defibrillator implantation were enrolled.
- Duplex ultrasonography was used to identify the cephalic vein's surface location and depth.
- Surgical findings were compared with pre-procedural imaging and the deltopectoral groove method.
Main Results:
- Pre-procedural duplex ultrasonography successfully isolated all proximal cephalic veins.
- Sonographic localization was significantly more accurate than the deltopectoral groove method (0.5 vs. 4.9 mm).
- Cephalic vein depth correlated strongly with surgical findings (r=0.93) and BMI (r=0.70).
Conclusions:
- Pre-procedural duplex ultrasonography is effective for cephalic vein localization and isolation.
- Sonography provides superior surface localization compared to the deltopectoral groove method.
- A strong linear relationship exists between BMI and cephalic vein depth.
Background:
Difficulty in isolating the cephalic vein contributes to failed pacemaker and intracardiac cardioverter-defibrillator (ICD) implantation via the cephalic venous approach. The deltopectoral groove is used as a rough landmark, but the vein is often not found here. We evaluated the benefit of pre-procedural duplex ultrasonography in isolating the cephalic vein.
Methods:
We enrolled 80 consecutive patients undergoing new pacemaker or defibrillator implantation and performed duplex ultrasonography to localize the cephalic vein before implantation. The corresponding surface location in the infraclavicular region and the depth of the cephalic vein were identified and recorded if the vein was well visualized. Using the imaging results, we dissected the skin over the predicted location until the cephalic vein was isolated. We determined the depth and corresponding surface location of the proximal cephalic vein during surgery. Afterward, we compared localization of the vein using imaging, surgery, and the deltopectoral-groove method. The relationship between cephalic vein depth and body parameters was also evaluated after the procedure.
Results:
All proximal cephalic veins were successfully isolated under the assistance of pre-procedural duplex ultrasonography. When the corresponding surface locations were compared, the location depicted on sonograms was closer to the surgical finding than the location determined by using the deltopectoral-groove method (0.5 +/- 3.9 vs. 4.9 +/- 9.6 mm; P < .001). The depth of the cephalic vein derived from duplex sonograms showed excellent correlation with the surgical findings (r = 0.93, P < 0.001). The cephalic vein depth and body mass index (BMI) also showed a linear relationship with good correlation (r = 0.70, P < 0.001).
Conclusion:
Pre-procedural duplex ultrasonography helped in localizing the proximal cephalic vein and isolating the cephalic vein. Surface localization of the proximal cephalic vein was superior with sonography than with the deltopectoral-groove method. There was a linear relationship with good correlation between BMI and cephalic vein depth.
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