ABSTRACT
BACKGROUND:
Cephalic
vein cutdown (CVC) and
subclavian vein puncture (SVP) are the most commonly used access sites for transvenous
lead placement of cardiac implantable
electronic devices (CIEDs). Limited
knowledge exists about the long-term patency of the vascular lumen
housing the leads.
METHODS:
Among the 2703
patients who underwent CIED
procedures between 2005 and 2013, we evaluated the
phlebographies of 162
patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The
phlebographies were divided into four
stenosis types Type I = 0%, Type II = 1-69%, Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized
stenosis categorization exists, experienced
physicians in
consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of
stenosis Type III or IV in the CVC group and in the SVP group.
RESULTS:
In total, 162
patients with
venography were enrolled in this study. The
prevalence of high-degree
stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group,
venographies showed a lower median
stenosis (33%) than in the SVP group (median 42%).
CONCLUSIONS:
The present study showed that the long-term patency of the
subclavian vein is higher after CVC than after SVP for venous access in
patients with CIED.