Study of Extrathoracic Subclavian/Axillary Vein Puncture with a Novel Technique using Micro-Wire as a Guide for Device Lead Implantation

Background: Cannulation of veins for Cardiovascular implantable electronic devices (CIED) therapy always involves some risk of complication. To prevent lead related complications, most operators now prefer large veins like proximal part of subclavian vein and axillary vein. A novel technique of subclavian/axillary vein puncture is described where a “microwire”, a routine 0.014 PCI wire is used as a guide to obtain vascular access. Aims and Objectives: To study safety and efficacy of a novel technique of subclavian/axillary vein puncture using a microwire. Materials and Methods: 67 adult patients admitted for routine device therapy requiring 114 lead implantations were included. A 20 gauge IV cannula was introduced on medial side of anticubital area in ipsilateral arm. Through this cannula, PCI wire was advanced via axillary vein to right atrium under fluoroscopy. Same microwire was used to guide access of subclavian/ axillary vein over first rib. Results: One patient was excluded due to absence of any visible vein. In 66 patients, all 112 subclavian/axillary vein cannulations were successfully performed using microwire guidance technique. Success was achieved in first attempt for 86 (76.8%), in second attempt for 18 (16%) and in third attempt for 8 (7.2 %) punctures. No complications related to punctures were observed. Conclusion: This technique of extra-thoracic, subclavian/axillary vein cannulations using a ‘micro-wire’ introduced through ipsilateral arm vein is simple, safe and more predictable for device lead implantation. Puncture is virtually done under vision as radiopaque micro-wire serves as a real-time landmark of position and course of vein over first rib.