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Clinical implications of cephalic vein morphometry in routine cardiac implantable electronic device insertion
R Steckiewicz1, E Świętoń, P Stolarz
1Department of Cardiology, Medical University of Warsaw. r.steckiewicz@pro.onet.pl.
Insights
Atypical cephalic vein (CV) anatomy, including small diameter and sharp curves, frequently complicates cardiac implantable electronic device (CIED) lead placement. Understanding these venous variations is crucial for successful CIED procedures.
Area of Science:
- Vascular anatomy
- Medical device implantation
Background:
- Successful cardiac implantable electronic device (CIED) insertion relies on understanding venous vasculature morphometrics.
- Cephalic vein (CV) variations significantly impact CIED implantation procedures.
Purpose of the Study:
- To present morpho-anatomical variations of the cephalic vein (CV).
- To evaluate the effect of these CV variations on CIED implantation procedures.
Main Methods:
- Analysis of contrast venography during first-time lead placement.
- Venography performed for problematic lead introductions via CV cutdown or axillary/subclavian vein puncture.
- Categorization of 214 venographies into 9 subgroups based on CV variations limiting CV cutdown.
Main Results:
- Unfavorable CV morphometric parameters for lead placement included diameter ≤ 1 mm (18%), sharp terminal CV curvature (14%), and terminal CV bifurcation (9%).
- Other limiting variations: additional CV branches/tributaries (7%), stenoses (5%), winding course (5%), and single supraclavicular CV (4%).
Conclusions:
- Radiographic records enabled assessment of atypical CV variation prevalence.
- Characteristic and rare CV variations were identified and graphically presented.
Background:
Morphometric parameters of the venous vasculature constitute an important aspect in successful cardiac implantable electronic device (CIED) insertion. The purpose of this study was to present morpho-anatomical variations of the cephalic vein (CV) and their effect on the course of CIED implantation procedures, based on the patients from our centre.
Materials And Methods:
We analysed contrast venography results obtained during first-time lead placement. Venography was indicated in the cases of problematic lead introduction with either the CV cutdown or axillary/subclavian vein puncture techniques. The 214 cases of venography (15%) performed out of 1425 first-time lead placement in the period 2011-2013 were divided into 9 subgroups according to the most commonly observed CV variations of similar morpho-anatomical features that limited the use of the CV cutdown technique for lead insertion.
Results:
The following CV morphometric parameters were found to be unfavo-urable in terms of lead placement: CV diameter of ≤ 1 mm (18%), sharp curva-ture of the terminal CV segment as it joined the axillary vein (14%), terminal CV bifurcation (9%), additional CV branches (7%) or tributaries (7%), stenoses (5%), sharply winding course (5%), single CV with a supraclavicular course (4%).
Conclusions:
The radiographic records obtained during the procedures allowed us to assess the prevalence of those atypical CV variations in our study group, with graphic presentation of characteristic types and sporadically reported CV variations.
