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Axillary vein technique for pacemaker and implantable defibrillator leads implantation: a safe and alternative approach?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Migliore, Federico Curnis, Antonio Bertaglia, Emanuele
Description	Country affiliation: Italy Author Affiliation: Migliore F ( aDepartment of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova bDepartment of Cardiology, Spedali Civili, University of Brescia, Brescia, Italy.)
Abstract	Different methods for venous access are used for permanent pacemaker or implantable cardioverter defibrillator (ICD), of which subclavian vein puncture technique is the most widely practised. Although this approach is relatively easy to learn, quick and offers high success rates, it may be associated with potential serious acute complications including pneumothorax, emopneumothorax, brachial plexus injury and longer-term complications such as lead fracture, loss of lead insulation and subclavian crush syndrome especially in young patients with ICD leads. Axillary vein approach seems to be a favourable technique not only for the prevention of acute complications but also to reduce lead failure including lead insulation and lead fracture prevention with a consequently better long-term lead survival compared with the classical subclavian approach. Although randomized studies are lacking, recent reports not only evaluated the safety and effectiveness of new fluoroscopic axillary venous puncture technique, but also compared it with the conventional intrathoracic subclavian venous puncture technique for the implantation of leads in permanent pacing. Various techniques of axillary vein puncture have been proposed ranging from a blind percutaneous puncture to the use of different tools such as contrast venography and ultrasound. In this article, we report a case of subclavian crush syndrome, the use of a modified Bellot's technique of axillary vein puncture that we currently use and the potential benefits of axillary vein puncture for pacemaker and ICD leads implantation compared with subclavian approach to avoid acute and long-term lead complications.
File Format	HTM / HTML
ISSN	15582027
Issue Number	4
Volume Number	17
e-ISSN	15582035
Journal	Journal of Cardiovascular Medicine
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2016-04-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Cardiology Discipline Vascular Diseases Axillary Vein Defibrillators, Implantable Pacemaker, Artificial Prosthesis Implantation Methods Ventricular Fibrillation Therapy Adult Fluoroscopy Heart Arrest Etiology Prevention & Control Humans Male Prosthesis Failure Adverse Effects Radiography, Interventional Subclavian Vein Injuries Complications Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Cardiology and Cardiovascular Medicine

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Axillary vein technique for pacemaker and implantable defibrillator leads implantation: a safe and alternative approach?