Subpectoral venous approach for ICDs

Lead complications may have fatal consequences for ICD patients. Lead fract ures have been reported to occur a long time after subclavian puncture duri ng ICD-implantation. Damage can also be caused by the patient manipulating subcutaneous lead segments. In this report we describe a simple implantatio n technique which avoids the risks related to subcutaneous lead position an d transmuscular subclavian vein puncture. In 16 patients, after preparation of the site of the device, we chose the s ubpectoral venous approach for the implantation of the leads from the ICD. Available approaches are the pectoral vein, the subpectoral section of the cephalic vein or a puncture of the subclavian vein which is fully visible f rom that size. Once the pectoral muscle has been sutured, the entire system is protected behind it. Apart from an early postoperative lead dislocation, no complications were o bserved in association with the operating technique within a mean followup period of 10.7 +/- 6.7 (SD) months. The advantages of this technique are as follows: There is no transmuscular subclavian puncture or exposure of the deltoideopectoral groove. The en tir e ICD system is situated under the pectoralis major muscle. Subcutaneous le ad positions with the potential complications mentioned above can thus be a voided. The fact that a more complex technique and therefore a slightly len gthier operating time is required and that this technique is not particular ly suitable for local anaesthesia may be regarded as disadvantages. Due to the small number of cases and the short follow-up period, a final conclusio n on the application of this technique is not possible to date.