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Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
Cephalic Vein Cutdown Is Superior to Subclavian Puncture as Venous Access for Patients with Cardiac Implantable
Dario Knorr1, Dirk Bandorski2, Harilaos Bogossian1,3
1Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany.
Insights
Cephalic vein cutdown (CVC) offers better long-term subclavian vein patency for cardiac implantable electronic device (CIED) lead placement compared to subclavian vein puncture (SVP). This reduces the risk of high-degree stenosis after CIED procedures.
Area of Science:
- Cardiology
- Vascular Access
- Medical Device Implantation
Background:
- Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are primary venous access methods for cardiac implantable electronic devices (CIEDs).
- Long-term vascular lumen patency after CIED lead placement is not well-established.
- Understanding long-term outcomes of different venous access sites is crucial for patient management.
Purpose of the Study:
- To compare the long-term patency of the subclavian vein between CVC and SVP access for CIED lead placement.
- To evaluate the incidence of high-degree venous stenosis at these access sites over time.
Main Methods:
- Retrospective analysis of 162 patients undergoing elective CIED replacement, with venography performed a median of 6.4 years post-implantation.
- Patients were grouped based on initial venous access: CVC (n=89) or SVP (n=73).
- Venous stenosis was categorized into four types, with high-degree stenosis defined as Type III (70-99%) or Type IV (occlusion).
Main Results:
- The prevalence of high-degree stenosis was significantly lower in the CVC group (7.8%) compared to the SVP group (20.5%; p=0.023).
- Median stenosis was lower in the CVC group (33%) than in the SVP group (42%).
- These findings indicate superior long-term venous lumen patency with CVC.
Conclusions:
- Cephalic vein cutdown (CVC) demonstrates better long-term subclavian vein patency than subclavian vein puncture (SVP) for CIED lead placement.
- CVC is associated with a lower risk of developing significant venous stenosis over time.
- This suggests CVC may be a preferable venous access strategy for long-term CIED patient care.
Background:
Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the most commonly used access sites for transvenous lead placement of cardiac implantable electronic devices (CIEDs). Limited knowledge exists about the long-term patency of the vascular lumen housing the leads.
Methods:
Among the 2703 patients who underwent CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1-69%, Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized stenosis categorization exists, experienced physicians in consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of stenosis Type III or IV in the CVC group and in the SVP group.
Results:
In total, 162 patients with venography were enrolled in this study. The prevalence of high-degree stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%) than in the SVP group (median 42%).
Conclusions:
The present study showed that the long-term patency of the subclavian vein is higher after CVC than after SVP for venous access in patients with CIED.
