Standardised procedure for pacemaker axillary vein puncture

Area of Science:

• Cardiovascular Interventions
• Medical Imaging
• Anatomical Studies

Background:

• Axillary vein access is a promising alternative to subclavian venous access for pacemaker implantation, potentially reducing infection risk and improving success rates.
• Standardized protocols for fluoroscopy-guided axillary vein puncture are currently lacking.

Purpose of the Study:

• To evaluate the feasibility of a simplified fluoroscopic technique for axillary vein puncture.
• To identify anatomical and clinical predictors of procedural success for axillary vein access.

Main Methods:

• Retrospective cohort study of 178 patients undergoing pacemaker implantation.
• Patients stratified by fluoroscopic puncture technique: RAO 30°, Caudal 35°, or vein-guided.
• Analysis of demographic data, comorbidities, smoking status, and radiographic parameters (subclavian fat thickness, clavicle-first rib angle).

Main Results:

• High success rate of 94.9% (169/178) for axillary vein puncture without venography.
• Predictors of success included sex-specific anatomy, BMI ≥ 23.84 kg/m², and clavicle-first rib angles.
• Low complication rate of 1.69%, with no severe events like pneumothorax or lead dislodgement.

Conclusions:

• Fluoroscopy-guided axillary vein puncture success is critically dependent on patient-specific anatomy (sex, BMI, clavicle-first rib relationships, smoking status).
• The standardized protocol demonstrated high efficacy and safety without ultrasound, proving useful in resource-limited environments.