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Review
. 2021 Sep 26;37(6):1506-1511.
doi: 10.1002/joa3.12639. eCollection 2021 Dec.

Axillary vein access using ultrasound guidance, Venography or Cephalic Cutdown-What is the optimal access technique for insertion of pacing leads?

Lloyd Davis  1   2   3 , William Chik  1   2   3   4 , Saurabh Kumar  1   2   3 , Gopal Sivagangabalan  1   2   3   4 , Stuart P Thomas  1   2   3 , A Robert Denniss  1   3
Affiliations
Review

Axillary vein access using ultrasound guidance, Venography or Cephalic Cutdown-What is the optimal access technique for insertion of pacing leads?

Lloyd Davis et al. J Arrhythm. .

Abstract

We reviewed the different approaches used for central vein access during insertion of cardiac implantable electronic devices. The benefits and hazards of each approach (cephalic vein cutdown, axillary vein cannulation using venography and ultrasound) are discussed. Each approach has its advantages and hazards that need to be considered for the individual patient and balanced against the skills of the operator. The benefits of ultrasound guided venous access in reducing radiation exposure to the patient and implanter, avoiding the need for angiographic contrast and in minimizing the risk of pneumothorax and inadvertent arterial puncture are highlighted. Trainees should be taught each approach to deal with patient variability. Ultrasound guidance should be considered as a mainstream option for most patients.

Keywords: axillary vein; pacemaker; ultrasound guidance.

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Conflict of interest statement

Authors declare no conflict of interests for this article.

Figures

FIGURE 1
FIGURE 1
Cephalic vein cutdown. The vein has been dissected from the surrounding fascia between the pectoralis major on the left of the photo and the deltoid muscle on the right of the photo. Surgical silk ties mark the vein and have been positioned to be able to ligate the vein proximally and distally to the planned puncture site
FIGURE 2
FIGURE 2
Venogram of the axillary vein. The needle can be seen indenting and puncturing the vein lateral to the first rib and inferior to the clavicle
FIGURE 3
FIGURE 3
Location of ultrasound probe lateral to first rib but medial to deltopectoral groove and immediately caudal to the clavicle
FIGURE 4
FIGURE 4
Short axis view of the axillary vein. The tissue planes are clearly seen with P marking the pleural boundary. Fluid (L.A.) from the local anaesthetic has distorted the tissue planes superficial to the vein. The vein lies caudal and more superficial to the artery. The vein is compressible with pressure from the probe but the artery not so. The inferior arrow points to the tip of the needle about to enter the axillary vein. The shaft of the needle is out of the ultrasound plane
FIGURE 5
FIGURE 5
Axillary vein puncture. The arrow shows the echogenic reflection of the needle entering the axillary vein
See this image and copyright information in PMC

References

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