ULTRASOUND GUIDED AXILLARY VEIN ACCESS: AN ALTERNATIVE APPROACH FOR VENOUS ACCESS FOR CARDIAC DEVICE IMPLANTATION

Abstract Funding Acknowledgements Type of funding sources: None. Background Venous obstruction is relatively common after cardiac implantable electronic device (CIED) implantation. After CIED implantation 15% of the patients present with a severe or total occlusion. This poses a problem during lead revisions or upgrades often leading to implantation failure or complex extraction or lead tunneling procedures. Percutaneous balloon venoplasty might be a suitable option but is rarely performed. Purpose To identify the feasibility and safety of venoplasty during cardiac device implantation procedures. Methods We retrospectively included consecutive cardiac device implantations in which venoplasty was performed during the same procedure from December 2018 until December 2020. The venoplasty was done either planned or ad hoc, by an interventional radiologist. Results We included 17 patients, 14 (82%) were male, aged 73 ± 11 years. Fifteen (88%) patients required an upgrade or lead revision and two were de novo implantations. The subclavian vein was the site of occlusion in 13 (76%) patients. In 16 (94%) patients venoplasty was successful and all intended leads could be implanted subsequently. In the patient with the unsuccessful recanalization both an antegrade and retrograde approach via the vena femoralis was attempted. No venoplasty related complications occurred. The figure shows a succesful upgrade from a single chamber ICD (panel A) to a CRT-D (panel D) after venoplasty for a total occulsion of the vena subclavia (panel B and C). Conclusions Percutaneous balloon venoplasty is a safe and feasible method for patients in whom venous access is an issue during CIED implantation. This method can be performed ad hoc and prevents contralateral lead implantation with tunneling or lead extraction. Abstract Figure. Venoplasty during upgrade.

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A modified approach for ultrasound-guided axillary venipuncture in the infraclavicular area: A retrospective observational study

The Journal of Vascular Access ◽

10.1177/1129729819838135 ◽

2019 ◽

Vol 20 (6) ◽

pp. 630-635

Author(s):

Minmin Yao ◽

Wanxia Xiong ◽

Liying Xu ◽

Feng Ge

Keyword(s):

Observational Study ◽

Success Rate ◽

Central Venous Access ◽

Demographic Data ◽

Venous Access ◽

Axillary Vein ◽

Ultrasound Guided ◽

Central Venous ◽

Venous Catheterization ◽

Out Of Plane

Background: Catheterization of the axillary vein in the infraclavicular area has important advantages in patients with long-term, indwelling central venous catheters. The two most commonly used ultrasound-guided approaches for catheterization of the axillary vein include the long-axis/in-plane approach and the short-axis/out-of-plane approach, but there are certain drawbacks to both approaches. We have modified a new approach for axillary vein catheterization: the oblique-axis/in-plane approach. Methods: This observational study retrospectively collected data from patients who underwent ultrasound-guided placement of an axillary vein infusion port in the infraclavicular area at the Central Venous Access Clinics of Zhongshan Hospital at Fudan University between March 2014 and May 2017. The patients’ demographic data, success rate of catheterization, venous catheterization site, and immediate complications associated with catheterization were recorded. Results: Between March 2014 and May 2017, a total of 858 patients underwent placement of an axillary vein infusion port in the infraclavicular area at our center. The ultrasound-guided oblique-axis/in-plane approach was used for all patients, and the venipuncture success rate was 100%. Two cases of accidental arterial puncture and one case of local hematoma formation were reported, and no other complications, such as pneumothorax or nerve damage, were reported. Conclusion: The ultrasound-guided oblique-axis/in-plane approach is a safe and reliable alternative to the routine ultrasound-guided approach for axillary venous catheterization.

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A new central venous access in Emergency Department: ultrasound-guided infraclavicular axillary vein

Critical Ultrasound Journal ◽

10.1186/2036-7902-7-s1-a7 ◽

2015 ◽

Vol 7 (S1) ◽

Author(s):

M Algaba-Montes ◽

A Oviedo-García

Keyword(s):

Emergency Department ◽

Central Venous Access ◽

Venous Access ◽

Axillary Vein ◽

Ultrasound Guided ◽

Central Venous

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Utility of Caudal Angulation for Venous Access under Fluoroscopic Guidance during Cardiovascular Implantable Electronic Device Implantation

Cardiology ◽

10.1159/000515360 ◽

2021 ◽

pp. 1-5

Author(s):

Siddharthan Deepti ◽

Dhara Singh ◽

Nirmal Ghati ◽

Manish Shaw ◽

Nitish Naik ◽

...

Keyword(s):

Ct Angiography ◽

Electronic Device ◽

Lung Parenchyma ◽

Venous Access ◽

Axillary Vein ◽

Fluoroscopic Guidance ◽

Bony Landmark ◽

Rib Cage ◽

Device Implantation ◽

Cardiovascular Implantable Electronic Device

Background: Axillary venous access is preferred for CIED implantation. The procedure is usually performed under fluoroscopic guidance in anteroposterior (A-P) view. However, there is a lack of perception of depth in this view with a fear of creating complications. Caudal fluoroscopy (adding 30°–35° caudal angulation to A-P projection) has been proposed to circumvent this problem. Objective: The aim of this study was to elucidate the advantages of caudal fluoroscopy using fluoroscopic images, contrast venograms, and CT angiography images of axillary vein. Methods: The fluoroscopic images and contrast venograms obtained in the A-P view were compared with caudal fluoroscopy in patients undergoing CIED implantation at our centre. Also, the CT angiography images of axillary vein were reconstructed to understand the relative anatomy of the vein and the underlying lung parenchyma, simulating these 2 projections. Results: The CT angiography images, contrast venograms, and fluoroscopic images confirmed that caudal fluoroscopy allows better visualization of the vein in relation to the lung parenchyma and rib cage. Analysis of fluoroscopic images revealed that the bend of the first rib formed a conical prominence in caudal fluoroscopy. This served as an important bony landmark for successful venous access, which was usually obtained while the needle was being directed towards this prominence in caudal fluoroscopy. Conclusions: The proposed advantages of caudal fluoroscopy for CIED implantation have been elucidated by analysis of CT angiography images, contrast venograms, and fluoroscopic images.

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