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Subclavian venogram as a guide to lead implantation
W H Spencer1, D W Zhu, C Kirkpatrick
1Baylor College of Medicine, Houston, TX 77030, USA.
Pacing and Clinical Electrophysiology : PACE
|April 29, 1998
Summary
A new venogram technique for subclavian vein access in lead implantation proved safe and effective. This method facilitates lead placement and avoids complications, offering a reliable alternative for pacemaker and defibrillator procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Doubts exist regarding the safety and efficacy of blind subclavian venipuncture for intracardiac lead implantation.
- The blind technique may lead to complications and suboptimal lead placement.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel subclavian venogram technique for intracardiac lead implantation.
- To assess if a venogram-guided approach facilitates lead manipulation and minimizes "subclavian crush."
Main Methods:
- A simple subclavian venogram was performed via the ipsilateral brachial vein in 22 consecutive patients undergoing lead implantation.
- A total of 35 leads were implanted (31 left pectoral, 4 right pectoral) for permanent pacemakers and intracardiac defibrillators.
Main Results:
- Lead insertion using the venogram technique was successful in all 22 patients.
- Two minor, inconsequential arterial punctures occurred; no pneumothoraces, infections, or other complications were reported.
- The technique allowed for more lateral lead entry, potentially minimizing "subclavian crush."
Conclusions:
- Ipsilateral venogram-guided lead insertion is a safe and reliable method for subclavian vein access.
- This technique should be considered for patients requiring permanent lead placement via the subclavian vein approach.