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The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire
07:47

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An unusual case of the cephalic vein with a supraclavicular course

Ernest W Lau1, Reginald Liew, Stuart Harris

  • 1Department of Cardiology, St. Bartholomew's Hospital, London, UK. ernest.lau@btinternet.com

Pacing and Clinical Electrophysiology : PACE
|April 28, 2007
PubMed

Insights

Device implanters should recognize an uncommon cephalic vein anomaly that can complicate pacemaker lead placement. This anatomical variation requires awareness to prevent potential damage during transvenous lead insertion.

Area of Science:

  • Cardiovascular Surgery
  • Medical Device Implantation
  • Anatomy

Background:

  • Transvenous lead placement for pacemakers and defibrillators typically utilizes subclavian or axillary vein access.
  • Some implanters prefer cephalic vein cutdown due to concerns about pneumothorax and subclavian crush during central venous access.

Observation:

  • An anatomical anomaly exists where the cephalic vein crosses superficial to the clavicle, joining the external jugular vein.
  • This superficial course makes the cephalic vein an unappealing target for standard venous access procedures.

Findings:

  • Attempting to use a guidewire through this anomalous cephalic vein to puncture the subclavian vein is often unsuccessful.
  • This technique carries a risk of accidental damage to critical structures within the thoracic inlet region.

Implications:

  • Awareness of this cephalic vein anatomical variation is crucial for device implanters.
  • Understanding this anomaly is essential for safe and effective transvenous lead placement, preventing potential complications.

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