Acesso aberto Revisado por pares
Artigo de Revisao

Puncture of the Axillary Vein for the Implant for Electronic Cardiac Devices

Punçao da Veia Axilar para o Implante de Dispositivos Cardíacos Eletrônicos

Vagner Rossato Pegoraro1,*; E duardo Rodrigues Bento Costa1; Luiz Fernando Fagundes Gouvea1; Beatriz Tose Costa Paiva2

DOI: 10.24207/jac.v32i1.511_PT


INTRODUÇAO: A obtençao do acesso venoso para implante de dispositivos cardíacos eletrônicos implantáveis (DCEIs) tem sido tradicionalmente feita por meio da punçao da veia subclávia intratorácica (PVS) ou por flebotomia da veia cefálica (FVC). Evidências apontam, entretanto, para o risco aumentado de complicaçoes a curto e longo prazos com a PVS pelo fato de ser um acesso intratorácico e pelo risco de compressao dos eletrodos pelo ligamento costoclavicular, levando a diferentes tipos de defeitos. A FVC, por sua vez, tem sido associada à taxa de insucesso que chega a 45%. A punçao da veia axilar (PVA) tem sido descrita na literatura e é apresentada, aqui, como alternativa às duas técnicas mencionadas.
MÉTODOS: Realizou-se uma pesquisa pelo PubMed sobre artigos que mencionam as técnicas de PVA, PVS e FVC e que as comparam quanto aos resultados imediatos, a curto e longo prazos e taxas de sucesso para a obtençao do acesso venoso. Deu-se ênfase às comparaçoes entre as diversas técnicas de PVA.
CONCLUSAO: A técnica de PVA para obtençao do acesso venoso apresenta algumas variaçoes entre os diversos autores. Ela tem segurança semelhante à da FVC, taxas de sucesso comparáveis às da veia subclávia e melhores resultados a médio e a longo prazos para a funçao dos eletrodos.

Punçao da veia axilar; Flebotomia da veia cefálica; Punçao da veia subclávia; Complicaçoes com implante de marcapassos.


Citation: Pegoraro VR, Costa ERB, Gouvea Filho LFF, Paiva BTC. Puncture of the Axillary Vein for the Implant for Electronic Cardiac Devices. Arq Bras Cardiol 32(1):17. doi:10.24207/jac.v32i1.511_PT
Received: Fevereiro 18 2018; Accepted: Julho 09 2018


Obtaining venous access for implantation of implantable cardiac devices (ICDs) is an essential part of the procedure. The choice of puncture technique should take into account factors such as the chance of success, the risks of immediate and future complications and the time required to obtain them. Several techniques have been described, all with their particularities and limitations. The intrathoracic subclavian vein puncture (SVP) technique was introduced by Littleford et al.1, in 1979. It was widely accepted because it is fast, easy to learn, and has high success rates. Thus, it has been the most widely used electrode implant method in the world2-4. In Brazil, this is also the most used venous access, followed by cephalic vein phlebotomy (CVP). Subclavian access, however, is associated with a greater risk of both immediate complications - pneumothorax, hemothorax, arterial puncture, brachial plexus injury and late - insulation defects, electrode fractures, capture losses, abnormal impedances and sensing failures5,6. CVP, although quite safe, has been less and less used due to the failure rate that varies from 15 to 45%7.In this work, we will review the axillary vein puncture technique (AVP), presenting the similarities and variations between the different authors, as well as their respective success rates, and compare it with the other techniques.



A PubMed survey was conducted on articles that mention AVP techniques. Those who described the AVP techniques or those who compared them to those of SVP or CVP were selected for immediate, short- and long-term results, and success rates for obtaining venous accesses.The survey covers articles published between 1979 and 2017. Emphasis was placed on comparisons between the various AVP techniques.



The axillary vein originates from the junction of the cephalic and basilic veins. It extends to the lower margin of the first rib where it continues as the subclavian vein ending with its junction with the internal jugular8.

AVP can be performed using contrast venography, contrast-free fluoroscopy, ultrasonography, or even anatomical landmarks only.

For fluoroscopy-guided AVP, data from venography studies that evaluate the usual path of the axillary vein are used. One demonstrated that the axillary vein runs parallel to the deltopectoral sulcus (DPS) between one finger (1.85 cm) and one finger and a half (2.8 cm) more medially and follows its course towards the most prominent point of the clavicle (MPPC)9.

This MPPC approximately corresponds to the crossing of the clavicle with the lateral margin of the first rib10,11. The axillary vein in its course parallel to the DPS also passes over the anterior body of the second rib, at the point where it crosses over the posterior shadow of the third rib (lateral radiological limit of the rib cage). Thus, with fluoroscopy, the needle can be directed to one of these two points from the pacemaker pocket (Fig. 1).

To reach these points, several authors have used varied techniques that can be generally grouped into two methods. In the first one, it begins by making the incision to the IECD pocket below (1.5-2 cm) and parallels to the clavicle, with this extending to the DPS. Then, the puncture needle is coupled to a syringe and puncture is performed from the IECD pocket. The tip of the needle is placed from the IECD pocket under fluoroscopy on the first rib, with an initial angle of approximately 60º (steep angle) in relation to the body surface (BS). The needle is then advanced and if it passes from the rib margin it is partially withdrawn and reintroduced with a greater angle (which can reach 90º) so that it is always seen on the first rib while it is advanced. From the moment it touches the rib, aspiration begins at the same time the needle is slowly drawn back. If blood cannot be aspirated, the process is repeated a little more laterally or medially, always with the needle on the radiological image of the first rib. The same technique can be used with the needle directed to a second target: the second rib body at the point where it intersects with the posterior shade of the third rib - which leads to more lateral puncture of the vein. Care should be taken that the needle always points to the anterior arch of the target rib since the inadvertent choice of a posterior arch may cause the needle to cross the intercostal muscles and the puncture result in a pneumothorax12,13.

In the second method, the incision can be made on the DPS or slightly medial to it (in the second case, it is approximately on the usual path of the axillary vein). The needle is inserted under fluoroscopy from the pacemaker's pocket at a lower angle (shallow angle) to the skin (10-30°), targeting the same crossing point of the clavicle with the lateral face of the first rib.This puncture angle allows greater needle reaches to puncture the axillary vein from the DPS (Fig. 2). This method of puncture was first described by Byrd10and subsequently used by others14.

Magney15 was the first to use anatomical landmarks for AVP, which was done transcutaneously. Gardini and Benedini16, using the same anatomical references, began to perform the puncture from the inside of the IECD pocket, both described in Table 1. The techniques that came after the axillary vein were targeted in their passage through the crossing of the lateral margin of the first rib with the clavicle (CC1C) or more lateral portions of this, in the latter case, on the crossing of the anterior aspect of the second rib with the posterior shadow of the third. For this purpose, the DPS (or cephalic vein) can be used as the anatomical landmarks as the point of origin and the MPPC as the target point.The latter, being palpable, serves as a target to guide the direction of the needle. With the knowledge that the axillary vein passes 1.8-2.8 cm medially to the DPS, the needle - aligned with the vein path - is directed to the place where the MPPC is palpated9,17. In this case, the puncture should be made on the superficial pectoral muscles with a small angle (up to 30º) in relation to BS. If success were not achieved, it would be possible to use fluoroscopy with contrast venography from cannulation of the cephalic vein (if it was dissected to be used as a reference) or from a peripheral vein to identify any anomalous path17.

Table 1. Comparisons between axillary vein puncture techniques.
References Incision for the IECD pocket XR Puncture site/target /angle Sucess rate
Magney et al.15 Not described No Entry (percutaneous puncture): junction of the 1/3 middle and 1/3 lateral of a line between PC and MEA midpoint.Target: 1/3 medial junction with 1/3 medial clavicle. Not described
Ramza et al.25 Parallel to the clavicle (2 cm below) Yes XR+C Target: 1) Axillary vein in more medial or "in" portion of the rib cage; 2) Axillary vein in more lateral or "out" portion of the rib cage.*Angle: 60º with SC. Parallel to the vein. Medial: 100% Lateral: 83%
Gardini et al.16 Parallel to the clavicle (2 cm below) No Modified Magney's technique, same references, but with the puncture from the inside of the pocket and not percutaneous. 98%
Belott12 Starts slightly below the coracoid process and runs perpendicular to the DPS Yes Target: 1) First rib at the intersection with the clavicle; 2) Second rib on the lateral margin of the rib cage (where the anterior radiological remnant of the second rib crosses the posterior radiological shadow of the third rib).Angle: 60-90º (steep). 98,21%
Sharma et al.20 On the DPS Yes Entry: crossing point of the second rib, with radiological lateral margin of the rib cage.Angle: 60ºTarget: Crossing of the clavicle with the lateral edge of the first rib. 98,09%
Antonelli et al.11 Parallel to DPS(1 cm medial to it) and 2 cm below the collarbone Yes Entry: upper incision edge.Target: 1st rib crossing with the clavicle.Angle: tangential to the thoracic surface. 94,5%
Jiang et al.14 Parallel to clavicle No Entry and angles: Steep needle technique - the angle of 60º in relation to BS.From point 2 cm medial to DPS.Shallow needle technique: From the lateral portion (closest to SCP) of the incision with a 10º angle to the BS.Target: 1/3 to 1/4 plus a medial portion of the clavicle. Blind/XRSteep: 51/54%Shallow: 89/94%
Mehrotra et al.9 Parallel to the DPS, 1 finger and a half medial to it. Top of the incision lies 2 fingers below the collarbone No Entry: with the needle in the direction of the incision (one finger and medial half to the DPS). Target: MPPCAngle: 60º in relation to BS 95%
Migliori et al.13 Parallel to the clavicle (2 cm below), extending up to 1 cm medial to DPS Yes Target: 1) Crossing the clavicle with the lateral edge of the first rib; 2) Body surface of the second rib (at the point where the anterior shadow of the second rib crosses the posterior shadow of the third)Angle: 60º. 93,2%
Imnadze et al.17 Parallel to the clavicle (2-3 cm below) going to the DPS, where the cephalic vein was dissected   Entry: 1.5-2 cm medial to the cephalic vein, leaving the needle parallel to it. Target: axillary vein in the most distal portion. Angle: 30º in relation to BS, with a needle parallel to the cephalic vein. 92,6%
Squara et al.19 Parallel to clavicle Yes Same Bellot technique. 81%

Target: vein point to be punctured [when more than one possible target point can be used (one or the other), have been set to 1 or 2]; MSA: manubrium-sternal angle; IECD: implantable electronic cardiac device; entry: entry point of the punch needle to then be directed to the target; PC: coracoid process; MPPC: most prominent point of the clavicle; RX: radioscopy/fluoroscopy; RX + C: contrast radioscopy; BS: body surface; DPS: deltopectoral sulcus; shallow: angle punch of approximately 10º-30º; steep: angle punch between 60º and 90º.

* Ramza used contrast venography and divided the axillary vein into medial and lateral. The medial portion corresponded to the vein "inside" the rib cage bone; the lateral portion to the axillary vein outside the limits of the rib cage.

in all patients from Ramza who did not succeed with a more lateral puncture, success was obtained when the most medial puncture was subsequently use d.

Jiang et al. initially tested for AP blindly, followed by fluoroscopy if it did not work

Pittiruti et al.18, in axillary vein Doppler studies, have shown that abduction of the arm, especially if associated with a certain shoulder elevation (with compresses behind the shoulder, for example), increased the diameter of the axillary vein and may facilitate its blind puncture18.



Obtaining venous access by the intrathoracic subclavian can be justified by the premise that the best way to do a procedure is to do the way one has the most experience. In fact, this has been the most used technique in Brazil and worldwide2-4. Several data, however, have shown that other forms of venous access with punctures that access the vascular bed in an extrathoracic location, such as AVP, may be equal or easier, safer, and present a lower risk of short- and long-term complications19-24.

Because the subclavian vein is a vessel with intrathoracic stroke, its puncture has been more associated with acute complications, especially the occurrence of pneumothorax (1.9-3.06%) when compared to AVP14,20,25 (Table 2). An example was a population cohort of 28,860 patients (Danish cohort) with IECD implantation evaluated for the occurrence of pneumothorax requiring drainage. The greatest predictor of its occurrence was obtaining access by SVP [odds ratio (OR) = 7.8; 95% confidence interval (95% CI) 4.9-12.5]26. The most frequent complication associated with AVP was the occurrence of an arterial puncture in the attempt to obtain venous access. CVP is practically not associated with acute complications, except for the possible occurrence of hematoma at the pocket location.

Table 2. Comparison between techniques for obtaining vascular access.
References Patients (n) Pneumothorax (%) Hemothorax (%) Arterial puncture (%) Pocket bruise (%) Brachial plexus injury (%) Limb thrombosis (%) Success (%)
Axillary vein                
    Sharma20 202 0.00 0.00 ND 4.40 ND ND 98.00
    Antonelli11 182 0.00 0.00 3.30 0.00 0.00 ND 100.00
    Imnadze17 108 0.00 0.00 4.60 ND 0.00 ND 92.60
    Jiang shallow14* 460 0.00 ND 7.50 0.50 0.00 ND 94.00
    Jiang steep14* 140 0.00 0.00 7.90 0.00 1.30 ND 54.00
    Migliori13 103 0.00 0.00 2.00 ND ND ND 100.00
    Byrd10 213 0.00 0.00 ND ND ND ND 98.00
    Saad27 241 0.00 0.00 5.00 ND ND 0.40 100.00
    Mehrotra9 20 5.00 ND ND ND ND ND 95.00
    Ramza25 50 0.00 0.00 8.10 ND ND ND 98.00
    Squara19 37 0.00 0.00 ND 2.70 5.40 ND 81.00
Subclavian vein                
    Sharma20 98 3.06 ND ND 4.00 ND ND 96.90
    Aggarwal29 1.047 1.80 ND 2.70 ND ND ND ND
    Chauhan30 1.892 0.6 ND ND 0.50 ND ND ND
    Litleford1 164 2.40 ND ND 1.20 ND ND 91.70
    Marinoni31 1.220 0.30 ND ND ND ND ND ND
    Kirkfeldt26 12.260 0.66 ND ND ND ND ND ND
    Eberhardt32 1.100 1.1 ND ND ND ND ND ND
    Fiorista33 101 3.00 ND ND ND 4.30 ND ND
    Hess34 171 0.00 0.00 ND ND 0.00 ND ND
Cephalic vein                
    Chauhan30 157 0.00 0.00 ND 2.60 ND ND ND
    Squara19 37 0.00 0.00 ND 5.40 0.00 0.00 75.70
    Kircanski35 44 0.00 0.00 0.00 0.00 0.00 0.00 90.10
    Parsonnet36 148 0.67 ND ND ND ND ND ND

ND: not described, unspecified or without separation of values between groups compared;

* Jiang shallow and steep are part of the same work but represent different axillary vein access techniques.

authors who defined as the occurrence of pneumothorax only the cases requiring drainage. Cases without drainage are not included;

cases of pneumothorax requiring drainage in which the implanted pacemaker was a double chamber.

The techniques described for AVP aim to use reference points that facilitate puncture without the risk of complications. If it is possible to perform it without the use of contrast, complications can be avoided such as spasm of the vein, nephropathy in patients with already depressed renal function, anaphylaxis or the need for adequate venipuncture ipsilateral to the puncture site. High success rates have been described for AVP using as reference fluoroscopic or only anatomical landmarks8,11,13,16,19,20, reserving the use of contrast for failure cases. When compared to the SVP technique, AVP has demonstrated similar success rates for vein cannulation19,20. AVP was even associated with a higher success rate in the first puncture attempt than SVP (61 vs. 36.8%),20. Although having a lower success rate, CVP has always been associated with greater safety, both because it is an extrathoracic technique and because it does not cause inadvertent risk of arterial puncture or brachial plexus injury. To test the safety of AVP, Squara et al.19 evaluated the AVP without the venography, comparing it with the CVP in a center where no electrophysiologist received any training or had any experience with the AVP. They only received material with a detailed description of the Belott technique before attempting to use the technique for the first time. With similar safety results - among them no pneumothorax - and high success rate, it has been shown that the lack of experience should not be impeding the adoption of AVP as a technique of choice19. A Brazilian study also confirmed its safety and efficacy27.

The techniques for AVP aim to use anatomical or radiological references for points on which the axillary vein passes more frequently, to facilitate the obtaining of the venous access. For this purpose, the various authors described their techniques with variations in relation to the pocket location, needle entry site, the target site for axillary vein puncture and needle angle for puncture. The latter can be large (60-90º - steep) or small, to the point of torsening the rib cage (10-30º - shallow) (Table 1). In general, when the pockets were made parallel to the clavicle, larger angles were used between the needle and SC, because there was greater proximity to the crossing of the first rib and clavicle (CC1C). In contrast, pockets parallel to DPS were associated with smaller angles for puncture when the target was CC1C - larger when the axillary vein was positioned more lateral (near the lateral radiological margin of the rib cage).

Ultrasonography can be used to guide the AVP. It certainly offers advantages such as direct visualization of the vessel and its anatomical relationships28, but it has the disadvantage that it is necessary to have this equipment in the room and also to extend the procedure.

When the possible consequences of the different types of access to the vascular bed on the durability of the electrodes were evaluated, important differences were observed.

Kim et al.22 compared the SVP technique with that of AVP in the insertion of 1,161 pacemaker electrodes. There was a 53% reduction in the risk of complications electrode fracture or defects in insulation - with axillary access compared to subclavian. Chan et al.23 followed the occurrence of failures in 681 implanted electrodes for an average period of 73.6 (± 33.1) months and the occurrence of defects was identified as 2.9%. AVP was an independent predictor for lower risk of electrode failure compared to SVP [hazard ratio (HR) = 0.26; 95% CI 0.071-0.954). Jacobs et al.24 made an even more detailed evaluation of defective electrodes extracted with the use of electrical tests, light microscopy, electron microscopy, and tests to evaluate the pressure on the electrodes. The analysis of the electrodes by specialists showed that the occurrence of pressure in the costoclavicular transition was responsible for the greater incidence of defects when the venous access was subclavian and suggested a more lateral approach, such as the use of the axillary vein, as a preventive for these complications.



The AVP technique has been described by several authors and presents some variations. It is a valuable alternative for obtaining venous access, presenting similar safety to CVP (even in the learning phase), success rates comparable to those of the subclavian vein and better medium and long term results for the function of the electrodes.



To Dr. Eduardo R. B. Costa for guiding us in this work.



Littleford PO, Parsonnet V, Spector SD. Method for the rapid and atraumatic insertion of permanent endocardial pacemaker electrodes through the subclavian vein. Am J Cardiol. 1979;43(5):980-2. https://doi.org/10.1016/00029149(79)90363-1 Link DOI Link PubMed
Bernstein AD, Parsonnet V. Survey of cardiac pacing in the United States in 1989. Am J Cardiol. 1992;69(4):331-8. https://doi.org/10.1016/0002-9149(92)90229-R Link DOI Link PubMed
Bernstein AD, Parsonnet V. Survey of cardiac pacing and defibrillation in the United States in 1993. Am J Cardiol. 1996;78(2):187-96. Link DOI Link PubMed
Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009 - A World Society of Arrhythmias project. Pacing Clin Electrophysiol. 2011;34(8):1013-27. https://doi. org/10.1111/j.1540-8159.2011.03150.x. Link DOI Link PubMed
Kleemann T, Becker T, Doenges K, Vater M, Senges J, Schneider S, et al. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation. 2007;115(19):2474-80. https://doi.org/10.1161/CIRCULATIONAHA.106.663807 Link DOI Link PubMed
Dorwarth U, Frey B, Dugas M, Matis T, Fiek M, Schmoeckel M, et al. Transvenous defibrillation leads: high incidence of failure during long-term follow-up. J Cardiovasc Electrophysiol. 2003;14(1):38-43. https://doi.org/10.1046/ j.1540-8167.2003.02305.x Link DOI Link PubMed
Calkins H, Ramza BM, Brinker J, Atiga W, Donahue K, Nsah E, et al. Prospective randomized comparison of the safety and effectiveness of placement of endocardial pacemaker and defibrillator leads using the extrathoracic subclavian vein guided by contrast venography versus the cephalic approach. Pacing Clin Electrophysiol. 2001;24(4 Pt 1):456-64. Link DOI
Jiang M, Mao JL, He B. Clinical definition of the axillary vein and experience with blind axillary puncture. Int J Cardiol. 2012;159(3):243-5. https://doi.org/10.1016/j.ijcard.2012.05.089 Link DOI Link PubMed
Mehrotra S, Rohit MK. Prospective study to develop surface landmarks for blind axillary vein puncture for permanent pacemaker and defibrillator lead implantation and compare it to available contrast venography guided technique. Indian Heart J. 2015;67(2):136-40. https://doi.org/10.1016/j.ihj.2015.04.007 Link DOI Link PubMed
Byrd CL. Clinical experience with the extrathoracic introducer insertion technique. Pacing Clin Electrophysiol. 1993;16(9):1781-4. https://doi.org/10.1111/j.1540-8159.1993. tb01810.x Link DOI Link PubMed
Antonelli D, Feldman A, Freedberg NA, Turgeman Y. Axillary vein puncture without contrast venography for pacemaker and defibrillator leads implantation. Pacing Clin Electrophysiol. 2013;36(9):1107-10. https://doi.org/10.1111/pace.12181 Link DOI Link PubMed
Belott P. How to access the axillary vein. Heart Rhythm. 2006;3(3):366-9.https://doi.org/10.1016/j.hrthm.2005.10.031 Link DOI Link PubMed
Migliore F, Siciliano M, De Lazzari M, Ferretto S, Valle CD, Zorzi A, et al. Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads. J Interv Card Electrophysiol. 2015;43(3):263-7. https://doi.org/10.1007/s10840-015-0011-7 Link DOI Link PubMed
Jiang M, Gong XR, Zhou SH, Pu J, Mao JL, He B. A comparison of steep and shallow needle trajectories in blind axillary vein puncture. Pacing Clin Electrophysiol. 2013;36(9):1150-5. https://doi.org/10.1111/pace.1215 Link DOI Link PubMed
Magney JE, Staplin DH, Flynn DM, Hunter DW. A new approach to percutaneous subclavian venipuncture to avoid lead fracture or central venous catheter occlusion. Pacing Clin Electrophysiol. 1993;16(11):2133-42. https://doi.org/10.1111/j.1540-8159.1993.tb.01018.x Link DOI Link PubMed
Gardini A, Benedini G. Blind extrathoracic subclavian venipuncture for pacemaker implant: a 3-year experience in 250 patients. Pacing Clin Electrophysiol. 1998;21(11 Pt 2):2304-8. Link DOI
Imnadze G, Awad K, Wolff E, Amberger J, Franz N, Thale J, et al. A novel method of axillary venipuncture using the cephalic vein as a sole anatomic landmark. The Can J Cardiol. 2015;31(8):1067-9. https://doi.org/10.1016/j. cjca.2015.02.021 Link DOI
Pittiruti M, Biasucci DG, La Greca A, Pizza A, Scoppettuolo G. How to make the axillary vein larger? Effect of 90 degrees abduction of the arm to facilitate ultrasound-guided axillary vein puncture. J Crit Care. 2016;33:38-41. https://doi.org/10.1016/j.jcrc.2015.12.018 Link DOI Link PubMed
Squara F, Tomi J, Scarlatti D, Theodore G, Moceri P, Ferrari E. Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access. Europace. 2017;19(12):2001-6. https://doi.org/10.1093/europace%2Feuw363 Link DOI Link PubMed
Sharma G, Senguttuvan NB, Thachil A, Leong D, Naik N, Yadav R, et al. A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion. Can J Cardiol. 2012;28(5):542-6. https://doi.org/10.1016/j.cjca.2012.02.019 Link DOI Link PubMed
Holubec T, Ursprung G, Schonrath F, Caliskan E, Steffel J, Falk V, et al. Does implantation technique influence lead failure? Acta Cardiol. 2015;70(5):581-6. https://doi.org/10.2143/AC.70.5.3110519 Link DOI Link PubMed
Kim KH, Park KM, Nam GB, Kim DK, Oh M, Choi H, et al. Comparison of the axillary venous approach and subclavian venous approach for efficacy of permanent pacemaker implantation. 8-Year follow-up results. Circulation. 2014;78(4):865-71. https://doi.org/10.1253/circj.CJ-13-0884 Link DOI
Chan NY, Kwong NP, Cheong AP. Venous access and longterm pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown. Europace. 2017;19(7):1193-7. https://doi.org/10.1093/europace/euw147 Link PubMed
Jacobs DM, Fink AS, Miller RP, Anderson WR, McVenes RD, Lessar JF, et al. Anatomical and morphological evaluation of pacemaker lead compression. Pacing Clin Electrophysiol. 1993;16(3 Pt 1):434-44. Link DOI
Ramza BM, Rosenthal L, Hui R, Nsah E, Savader S, Lawrence JH, et al. Safety and effectiveness of placement of pacemaker and defibrillator leads in the axillary vein guided by contrast venography. Am J Cardiol. 1997;80(7):892-6. https://doi.org/10.1016/s0002-9149(97)00542-0 Link DOI Link PubMed
Kirkfeldt RE, Johansen JB, Nohr EA, Moller M, Arnsbo P, Nielsen JC. Pneumothorax in cardiac pacing: a populationbased cohort study of 28,860 Danish patients. Europace. 2012;14(8):1132-8. https://doi.org/10.1093/europace/eus054 Link DOI Link PubMed
Saad EBFF, Veronese F, Maldonado P, Camanho LE. Uso do acesso venoso axilar para implante de eletrodos de marcapassos e desfibriladores. Relampa. 2006;19(4):259-99.
Orihashi K, Imai K, Sato K, Hamamoto M, Okada K, Sueda T. Extrathoracic subclavian venipuncture under ultrasound guidance. Circ J. 2005;69(9):1111-5. https://doi.org/10.1253/circj.69.1111 Link DOI Link PubMed
Aggarwal RK, Connelly DT, Ray SG, Ball J, Charles RG. Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems. Br Heart J. 1995;73(6):571-5. https://doi.org/10.1136/hrt.73.6.571. Link DOI Link PubMed
Chauhan A, Grace AA, Newell SA, Stone DL, Shapiro LM, Schofield PM, et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol. 1994;17(11 Pt 2):2012-5. Link DOI
Marinoni G, Broglia P, Bruno N, Perotti R, Bosatra C, Montemartini C. Percutaneous approach in the use of subclavian vein in pacemaker implantation. Giornale italiano di cardiologia. 1994;24(6):685-9. Link PubMed
Eberhardt F, Bode F, Bonnemeier H, Boguschewski F, Schlei M, Peters W, et al. Long term complications in single and dual chamber pacing are influenced by surgical experience and patient morbidity. Heart. 2005;91(4):500-6. https://doi.org/10.1136/hrt.2003.025411
Fiorista F, Lazari M, Marzegalli M, Piane C, Cotti R, Casazza F, et al. Use of the subclavian vein for permanent cardiac stimulation. Arch Inst Cardiol Mex. 1986;56(4):309-13. Link PubMed
Hess DS, Gertz EW, Morady F, Scheinman M, Sudduth BK. Permanent pacemaker implantation in the cardiac catheterization laboratory: the subclavian vein approach. Cathet Cardiovasc Diagn. 1982;8(5):453-8 Link DOI Link PubMed
Kircanski B, Vasic D, Savic D, Stojanov P. Low incidence of complications after cephalic vein cutdown for pacemaker lead implantation in children weighing less than 10 kilograms: A single-center experience with long-term follow-up. Heart Rhythm. 2015;12(8):1820-6. https://doi.org/10.1016/j.hrthm.2015.04.025 Link DOI Link PubMed
Parsonnet V, Roelke M. The cephalic vein cutdown versus subclavian puncture for pacemaker/ICD lead implantation. Pacing Clin Electrophysiol. 1999;22(5):695-7. Link DOI Link PubMed

© Todos os Direitos Reservados 2020 - Departamento de Estimulação Cardíaca Artificial da Sociedade Brasileira de Cirurgia Cardiovascular