造影指导下穿刺腋静脉植入起搏器电极导线

目的 探讨造影指导下穿刺腋静脉植入起搏器电极导线的方法.方法 2009年5月至2010年4月,共145例患者采用造影指导下穿刺腋静脉植入电极导线.经前臂静脉注射造影剂,记录腋静脉影像,以此为指导,行腋静脉穿刺.结果 穿刺腋静脉植入起搏器电极导线成功率为91.6%,穿刺成功组与穿刺不成功组平均年龄、性别比例差异无统计学意义,1例(0.7%)患者出现气胸,1例(0.7%)因误穿腋动脉并插入扩张管及外鞘导致皮下广泛出血,无电极导线磨损、断裂.结论 造影指导下穿刺腋静脉植入起搏器电极导线安全、有效,是起搏器电极导线植入的重要方法.     

经腋静脉远段穿刺植入起搏电极导线的可行性分析

目的 依据腋静脉走行及透视下腋静脉影像定义腋静脉近远段,利用静脉造影法分别穿刺腋静脉近、远段,探索腋静脉远段穿刺植入起搏电极的安全性及可行性.方法 选取于2019年5月至2020年5月于山西医科大学第一医院行心脏永久性起搏器植入的患者136例.根据起搏电极导线血管入路随机分为远段组、近段组,分别记录两组患者穿刺成功率、...     

经腋静脉植入起搏电极安装心脏永久起搏器的临床分析

<正>心脏永久起搏器目前已广泛应用于临床,起搏器的电极导线植入是心脏起搏器手术的关键步骤。经皮锁骨下静脉穿刺方法目前最为常用。但近年来有关经锁骨下静脉途径植入电极导线并发症报道(如气胸、锁骨下挤压综合征等)日渐增多,故有必要开展新的静脉途径植入电极导线。而腋静脉起始于第一肋外缘,因此起搏电极导管不受锁骨和第一肋夹角及肌肉韧带的挤压,故经腋静脉途径植入电极导线再次受到重视。虽然经腋静脉穿刺植入电极导线早在1987年即应用     

腋静脉造影引导经皮穿刺腋静脉植入心脏起搏器导线的临床价值

植入式心脏起搏器及其相关技术从最初简单的VVI到现在的双腔、三腔以及ICD和CRT-D.静脉内需长期放置的复杂电极导线也日益增多,无论是起搏器植入、更换还是电极重置,成功获得静脉入路都是植入起搏器的一个关键[1].获取静脉入路有3条,分别为头静脉入路、锁骨下静脉入路和腋静脉入路.头静脉入路常采用切开法获得,但头静脉的临床变异率较高,约20%.     

经锁骨下静脉远端穿刺埋置起搏器电极导线103例分析

为了探讨经锁骨下静脉远端穿刺埋置起搏器电极导线的安全性及减少电极导线断裂并发症的作用 ,对 10 3例应用该方法安置起搏器的患者进行了 0 .5～ 6年的随访观察。结果未发现与电极导线植入有关的并发症 ,包括经锁骨下静脉径路安置时较常见的电极导线断裂等严重并发症 ;说明该法有助于延长电极导线及起搏器的寿命。     

改良腋静脉穿刺技术应用于心脏起搏器电极植人手术的临床初步研究

目的观察改良腋静脉穿刺技术应用于心脏起搏器电极植入手术的有效性和安全性。方法选取2012年3月至2012年10月北京市中日友好医院收治的因病态窦房结综合征、房室阻滞或心房颤动伴心室长间歇而行永久心脏起搏器植入手术的患者50例,采用改良的腋静脉穿刺技术行起搏电极植入,观察围术期并发症情况,术后常规随访。结果50例患者均成功完成腋静脉穿刺,共植入起搏电极95根。手术期间未发生血胸、气胸、植入电极操作不顺等情况。随访时间（9．3±3．1）个月,所有患者的起搏参数未见明显异常。结论临床初步研究证实了改良的腋静脉穿刺技术的安全性和有效性。     

不同方法定位穿刺腋静脉植入起搏电极的临床研究

目的探讨3种不同定位方法穿刺腋静脉植入起搏电极的临床价值和安全性。方法根据随机表将患者分入体表解剖定位组(30例)、透视下骨性标志定位组(30例)、对比剂定位组(30例)以及锁骨下静脉组(对照组,30例),其中体表解剖定位组、透视下骨性标志定位组和对比剂定位组统称为腋静脉穿刺组。穿刺成功后按照常规方法植入各种起搏器和电极。观察4组不同穿刺方法的穿刺次数、所用时间、成功率及并发症发生情况。结果 120例患者均成功植入各种起搏器和电极。穿刺腋静脉各组与对照组比较,总穿刺成功率差异无统计学意义(P>0.05);对比剂定位组穿刺腋静脉成功率100%,但需要对比剂和准备时间;其次为透视下骨性标志定位组成功率93.3%;经体表解剖定位组和经锁骨下静脉穿刺组的穿刺成功率均为86.7%。腋静脉穿刺组穿刺次数中位数少于锁骨下静脉穿刺组(3比4,P<0.05);观察组穿刺平均耗时短于对照组[(3.9±1.3)min比(4.6±2.1)min,P<0.05]。对于心脏再同步化治疗,经腋静脉穿刺平均手术时间少于对照组(126.0±12.0)min比(146.0±16.0)min,P<0.05]。腋静脉穿刺组90例患者中共3例(3.3%,3/90)出现并发症,锁骨下静脉穿刺组30例患者中共5例(16.7%,5/30)发生并发症,两组并发症发生率比较差异有统计学意义(P<0.05)。结论 3种不同的定位方法穿刺腋静脉植入起搏电极均有很好的临床疗效和安全性,总体优于经锁骨下静脉穿刺术。     

经腋静脉和锁骨下静脉途径置入起搏器电极导线的对照研究

目的通过与锁骨下静脉穿刺置入起搏电极进行对照研究,探讨经腋静脉穿刺置入起搏器电极导线的可行性与安全性。方法入选118例起搏器植入患者,按简单随机法分为腋静脉组(n=66)与锁骨下静脉组(n=52),分别经腋静脉途径和经锁骨下静脉途径置入起搏导线。比较两种途径置入起搏导线的穿刺成功率和并发症。结果腋静脉组与锁骨下静脉组穿刺成功率分别为95.4%(63/66)和96.2%(50/52);两组并发症发生率分别为1.5%(1/66)和5.8%(3/52),两组患者穿刺成功率和并发症发生率均无统计学差异(P均0.05)。其中,锁骨下静脉组发生气胸3例,腋静脉组无一例发生气胸(P0.05)。结论经腋静脉途径置入心脏起搏器导线安全可行。     

腋静脉穿刺技术

腋静脉穿刺技术从1987年开始应用到临床以来，已经在静脉输液、麻醉及介入治疗中得到应用，特别是随着起搏技术的广泛开展，双腔、三腔起搏器及埋藏式心脏转复除颤器（ICD）置入量越来越大，通过锁骨下静脉的电极也越多，目前置入的起搏器电极大多为双极电极，双极电极较单极电极粗而且硬，这些都是增加锁骨下“挤压综合征”的因素，腋静脉穿刺是解决“挤压综合征”的有效方法，越来越受到电生理医生的关注，下面就腋静脉的优点、解剖、穿刺方法及存在的问题做一简要介绍。     

体表定位参考对侧斜位同侧造影的图像指导行腋静脉穿刺植入起搏器

目的 通过体表标识定位结合对侧斜位同侧造影的图像指导穿刺腋静脉,探讨一种更安全,成功率更高的穿刺技术.方法 选择2018年2月至2020年2月本科室需行心脏起搏器植入患者,采用锁骨下距离胸三角尖部3 cm处结合对侧斜位30°同侧造影的图像指导穿刺腋静脉植入起搏电极导线,观察穿刺成功率,穿刺相关并发症.结果 67例患者,...     

Placement of pacemaker leads via the extrathoracic subclavian vein guided by fluoroscopy and venography in the oblique projection

Blind needle puncture of the subclavian vein, which is the standard method used for insertion of pancemaker electrodes, causes an increased risk of lead fractures due to entrapment of the lead by the costoclavicular ligament and/or subclavius muscle. The extrathoracic lead insertion technique was developed to prevent such lead fractures. The present study was performed to evaluate the usefulness of extrathoracic subclavian vein puncture under the guidance of both fluoroscopy and venography in the oblique beam projection. Pacemaker leads were implanted in ten patients under the guidance of both fluoroscopy and venography in the ipsilateral anterior oblique projection. The angle of projection was set as large as possible between 35° and 45°. The needle was held parallel to the X-ray angle of incidence and inserted toward the first rib, then withdrawn until the tip entered the subclavian vein. This modified method of pacemaker implantation was successful in all patients, with no complications during the follow-up period ranging from 4 to 19 months. It also prevented pneumothorax and lead entrapment in soft tissue associated with the clavicle that might be caused by the conventional technique.     

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

Objective

To develop surface landmarks for blind axillary vein puncture for pacemaker lead implantation.

Methods and results

Patients for routine coronary angiography were counseled for participating in our study. 20 patients who gave consent were taken up for axillary venogram after proper positioning at the time of coronary angiogram. The venograms of these 20 patients, were reviewed and the landmarks were used to develop a blind axillary puncture technique. Success rate of 100% was achieved with surface landmark guided axillary vein puncture. The implantation time while using surface landmark guided axillary puncture was not significantly longer than when venography based approach was used. Another interesting observation made from the study was that increasing BMI had a positive correlation with the time taken for venous access, the fluoroscopic time and the volume of contrast used, all the associations being statistically significant. Thus, the surface landmark guided technique is more safe and expeditious in non obese patients and probably in pediatric patients as well. Moreover, the new surface landmark guided approach is a significant safety step in terms of reducing the unwanted and avoidable radiation exposure to the hands.

Conclusion

The results of this study demonstrate that placement of endocardial permanent pacemaker and ICD leads via the developed surface landmarks is effective and safe and is devoid of the harmful effects of radiation and contrast exposure.     

Clinical experience of contrast venography guided axillary vein puncture in biventricular pacing R1

BACKGROUND AND OBJECTIVES: Biventricular pacing is a new modality of treatment for patients with drug-refractory heart failure and ECG evidence of dyssynchronous ventricular contraction. A third lead is required to be placed in a coronary vein through the coronary sinus for left ventricular pacing, in addition to the atrial and right ventricular leads. Subclavian crush phenomenon is associated with lead placement using subclavian puncture. Cephalic venous cutdown, free of this complication, provides vascular access which is probably too small for multiple leads placement in biventricular pacing. Contrast venography guided axillary vein puncture (AP) is an alternative approach. This study reports on clinical experience of this technique in biventricular pacing. METHODS: AP is the method of choice for biventricular pacing in Princess Margaret Hospital and Stanford University Medical Center. Patients' clinical characteristics, effectiveness and safety of the technique were analysed. RESULTS: AP was performed in 35 patients, 29 male and six female with mean age 57.1 +/- 14.7 years from 1 January 2000 to 30 June 2001. Six patients had biventricular pacing alone and 29 patients had biventricular implantable cardioverter defibrillator (ICD) implanted. Twelve (34.3%) patients have ischaemic cardiomyopathy, 22 (62.9%) patients have dilated cardiomyopathy and one (2.9%) patient has hypertrophic cardiomyopathy. Six (17.1%) patients were in NYHA Class II heart failure, 21 (60.0%) patients were in Class III and eight (22.9%) patients were in Class IV. The mean EF was 23.1 +/- 7.6%. AP was attempted for placement of all three leads in all patients. AP was successful in 34 (97.1%) patients. The single failure was due to small size of the axillary vein. There were no AP, lead or contrast-related complications with a follow up of 12 months. CONCLUSIONS: AP is both effective and safe for biventricular pacing. It may be the method of choice in biventricular pacing.     

穿刺胸廓外锁骨下静脉和腋静脉安置永久起搏器电极

目的　评价穿刺胸廓外锁骨下静脉 (ESV)和腋静脉安置永久起搏器电极的方法。 1998年 8月～ 2 0 0 0年 1月 ,共 44例病人 ,男 2 6例 ,女 18例 ,年龄 37～ 82岁 ,病态窦房结综合征 33例 ,Ⅱ°～Ⅲ°房室传导阻滞 11例 ,其中双腔起搏器 2 8例。方法　X线下 ,用 18G针 ,于锁骨下第一肋外 2～ 3cm进针 ,与水平面成 45度 ,针头指向肋锁交界处锁骨下第一肋外缘至内缘间 ;若无回血 ,针头逐步向胸骨侧移动 ,范围 2cm ;针头始终触及第一肋是保证穿刺安全和成功的标志。另采用HP 5 5 0 0型彩色多谱勒血流显像仪 (CDFI)测定 2 5例正常成人ESV和腋静脉内径和解剖位置 ,探查部位在右上胸第一肋和第一肋以下。结果　 44例病人共穿刺 47例次均成功 ,其中ESV 46例次和腋静脉 1例次。每例穿刺次数 1～ 5次 ,平均 3次 ;进针深度 2～ 4cm ,平均 2 5cm。经皮穿刺点距锁骨 3～ 4cm ,针头入锁骨下静脉时距锁骨下 0 5～ 1 5cm。一例穿刺入锁骨下动脉 ,无其他并发症。CDFI测定ESV的走行在肋锁交界处第一肋上方 ,位置固定。结论　本方法安全、成功率高 ,避免了锁骨下和头静脉的缺欠和并发症 ,适于安置各种起搏电极。CDFI可指导穿刺ESV。本法远期效果尚待长期观察。     

Axillary vein puncture guided by ultrasound vs cephalic vein dissection in pacemaker and defibrillator implant: A multicenter randomized clinical trial

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置入双腔起搏心脏复律除颤器及经腋静脉送入心内电极的初步临床体会

目的初步评价新型双脏起搏心脏复律除颤器抗室性心动过速／心室颤动（室速／室颤）及心动过缓起搏的临床效果,了解经腋静脉送人心房及心室电极的安全性及有效性。方法７例室速及（或）室颤同时伴有心动过缓患者接受了双腔起搏心脏复律除颤器治疗,其中冠心病５例、扩张性心肌病２例。心房及心室电极均在Ｘ线透视、静脉注人造影剂指导下,直接穿刺腋静脉,从该静脉送人。结果脉冲发生器埋在左上胸皮下５例,埋在胸大肌与胸小肌之间２例。仪器对所有室速／室颤均能及时识别并成功治疗,同时提供有效的房室顺序起搏功能。所有心内电极均成功地经腋静脉送人,无并发症。结论双腔起搏心脏复律除颤器不但能有效地治疗严重室性心律失常,而且提供可靠的房室顺序性起搏功能。经腋静脉送入电极安全、可靠。     

起搏心电图引导经左锁骨下静脉床边临时心脏起搏的临床分析

目的 探讨起搏心电图引导经左锁骨下静脉途径行紧急床边临时心脏起搏技术的可行性及安全性.方法以seldinger法穿刺左锁骨下静脉置入鞘管,从鞘管推送电极至心电监护出现室性早搏或短阵室性心动过速,然后连接临时心脏起搏器,并设置起搏频率超过患者自主心率20次/min,输出电压为3～5 V,感知灵敏度为2 mV.起搏器完全起搏后,记录12导联心电图,并根据Ⅱ、Ⅲ、aVF导联起搏ORS图形调整电极位置,直至Ⅱ、Ⅲ、aVF导联起搏QRS主波向下,V1-V6导联起搏QRS呈完全性左束支阻滞图形.结果 8例患者获良好的起搏效果,全部一次插管成功,操作时间5～10 min,插管深25～30 cm.无手术相关并发症.结论由起搏心电图引导,经左锁骨下静脉行紧急床边临时心脏起搏是一种安全、有效、可行的方法,成功率高,值得推广应用.