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Original Article

. 2018; 9(4): 191-195


Study of Extrathoracic Subclavian/Axillary Vein Puncture with a Novel Technique using “Micro-Wire” as a Guide, for Device Lead Implantation

Ajaz Lone, Imran Hafeez, Irfan Ahmed Bhat, Aamir Rashid, Jahangir Rashid Beig, Nisar Tramboo.

Abstract
Background: Cannulation of veins for Cardiovascular implantable electronic devices (CIED) therapy always involves
some risk of complication. To prevent lead related complications, most operators now prefer large veins like proximal part
of subclavian vein and axillary vein. A novel technique of subclavian/axillary vein puncture is described where a “microwire”,
a routine 0.014 PCI wire is used as a guide to obtain vascular access. Aims and Objectives: To study safety and
efficacy of a novel technique of subclavian/axillary vein puncture using a microwire. Materials and Methods: 67 adult
patients admitted for routine device therapy requiring 114 lead implantations were included. A 20 gauge IV cannula was
introduced on medial side of anticubital area in ipsilateral arm. Through this cannula, PCI wire was advanced via axillary
vein to right atrium under fluoroscopy. Same microwire was used to guide access of subclavian/ axillary vein over first
rib. Results: One patient was excluded due to absence of any visible vein. In 66 patients, all 112 subclavian/axillary vein
cannulations were successfully performed using microwire guidance technique. Success was achieved in first attempt
for 86 (76.8%), in second attempt for 18 (16%) and in third attempt for 8 (7.2 %) punctures. No complications related
to punctures were observed. Conclusion: This technique of extra-thoracic, subclavian/axillary vein cannulations using a
‘micro-wire’ introduced through ipsilateral arm vein is simple, safe and more predictable for device lead implantation.
Puncture is virtually done under vision as radiopaque micro-wire serves as a real-time landmark of position and course
of vein over first rib.

Key words: Pacing, Axillary vein, Microwire.


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