A cephalic vein cutdown and venography technique to facilitate pacemaker and defibrillator lead implantation

The aim of this study was to assess the feasibility of a cephalic vein cutd own and venography technique for implantation of a pacemaker or ICD and to determine the causes of failure of cephalic vein cutdown. in consecutive pa tients who underwent pacemaker or ICD implants, a modified cephalic vein gu idewire technique uas performed. This technique was attempted in 289 pacema ker implants and 26 ICD implants (155 men, 160 women; mean age 74 +/- 10 ye ars). The success rate for implantation of a single chamber and a dual cham ber device by using this technique alone was 84% (54/64) and 74% (185/251), respectively (P = 0.10). In an additional 7% of patients with dual chamber implant, the cephalic vein can be used for passage of the ventricular lead . A cephalic venogram was required in 82 patients and facilitated the passa ge of the guidewire in 62 (79%) of them. No complication related to vascula r access was observed with this technique. This technique failed in 54 (17% ) of 315 patients due to (1) failure of cephalic vein isolation (48%), (2) venous stenosis (24%), or (3) venous torturosity or anomalies (28%). There were no significant differences in the patient's age, sex, type of device, and the fluoroscopic time for lead placement between patients with or witho ut successful lead placement using this technique (all P > 0.05). In conclu sion, a simple modification of the cephalic vein guidewire technique togeth er with venography has facilitated the placement of leads during pacemaker and ICD implant. This technique is safe and applicable in the majority of p atients and avoids the risk of subclavian puncture.