How to perform extrathoracic venous access for cardiac implantable electronic device placement: Detailed description of techniques

Heart Rhythm. 2022 Jul;19(7):1184-1191. doi: 10.1016/j.hrthm.2022.02.020. Epub 2022 Feb 26.

Abstract

Venous access is needed for implantation of cardiac implantable electronic devices (CIEDs) with endocardial leads. Extrathoracic venous access in the prepectoral region has become the standard of care for CIED implantation because of lower risks for pneumothorax and likely less lead malfunction due to subclavian crush syndrome. The most common extrathoracic venous access sites in the pectoral region are extrathoracic subclavian vein access, axillary vein access, and cephalic vein access. This review provides a detailed description of the anatomy, technical considerations, and relative advantages and disadvantages of each of these extrathoracic venous access sites.

Keywords: Axillary vein; Cardiac implantable electronic device; Cephalic vein; Implantable cardioverter-defibrillator; Lead malfunction; Pacemaker; Pneumothorax; Subclavian crush syndrome; Subclavian vein; Vascular access.

Publication types

  • Review

MeSH terms

  • Axillary Vein
  • Defibrillators, Implantable* / adverse effects
  • Electronics
  • Pacemaker, Artificial* / adverse effects
  • Subclavian Vein