SUBCLAVIAN VEIN ANATOMIC SUBTYPES DEFINED BY DIGITAL CINEFLUOROSCOPICVENOGRAPHY PRIOR TO PERMANENT PACEMAKER LEAD INSERTION

Digital cinefluoroscopic venography of the subclavian vein was perform ed in 26 consecutive patients. The optimal stored image of the anticip ated venipuncture site was magnified, roadmapped, and used to compare with fluoroscopic-guided venipuncture. Two anatomic subtypes for both subclavian veins were observed. For the left subclavian vein, a gradua l curve was seen most often (57%), while the remainder (43%) exhibited an ''s''-shaped curve. For the right subclavian, a gradual curve was observed most frequently (60%) while an acute 90 degrees angle was not ed in the remainder (40%). The ''s''-shaped curve in the left subclavi an vein necessitated redirection of the needle site both laterally and cranially. In three or 12% of patients venography showed either subcl avian thrombosis or a persistent left superior vena cava and lead inse rtion was moved to the opposite side. Successful venipuncture and subs equent cannulation of the subclavian vein was achieved with the first or second passage of the needle in 22 or 85% of the 26 patients. Digit al cinefluoroscopic venography appears to be both safe and rapid and m ay facilitate insertion of permanent pacemaker leads into the subclavi an vein. (C) 1996 Wiley-Liss, Inc.