CLINICAL-EXPERIENCE WITH THE EXTRATHORACIC INTRODUCER INSERTION TECHNIQUE

The extrathoracic approach to transvenous introducer insertion into th e subclavian vein was initially described as an alternative approach i n ''Safe Introducer Technique for Pacemaker Lead Implantation.'' Since this technique was so successful as an alternative approach, it was t ried as the primary approach in 213 consecutive cases. The subclavian vein was cannulated in all cases. There were no introducer related com plications. The extrathoracic approach cannulates the subclavian vein as it passes over the body of the first rib prior to entering the thor acic inlet. The technique includes maneuvering the introducer needle f rom the clavicle to the first rib by a series of partial withdrawals a nd reinsertions, visualized by fluoroscopy. The needle is advanced pos teriorly along the rib until the vein is punctured. Orientation is mai ntained by touching the rib with each maneuver. The early results of t he extrathoracic approach reinforces the belief that a complication-fr ee, transvenous introducer approach can be achieved.