Selective venography of the clavipectoral triangle during cardiovascular implantable electronic device (CIED) implantation

Background. Transvenous lead insertion into the cardiovascular system is currently the standard approach used during cardiac implantable electronic device (CIED) placement. Due to its lower risk of complications, the cephalic vein (CV) cutdown approach is the preferred method for cardiac lead insertion. In the case of difficulties in lead advancement, the local veins are angiographically visualized, with the vascular lumen enhanced via a contrast agent administered either, conventionally, into peripheral segments of veins of the forearm or, selectively, at the site of CV cut-down.

Objective. The aim of this study was to compare both venography techniques in terms of fluoroscopy time (FT), dose area product (DAP), and the volume of administered contrast.
Material and methods. A total of 100 CIED implantation procedures, where the cause of difficulties in lead advancement was visualized with intravenous contrast administration were assessed. In 50 cases, the contrast agent was administered using conventional peripheral venous access via veins of the forearm; in the other 50 cases via the cephalic vein exposed within the device pocket (selective venography). The evaluated parameters were contrast agent volume, FT, and DAP. Mann-Whitney test and the median test were used to assess the statistical significance of differences between the study groups.
Results. In comparison to conventional venography, selective venography of the vessels found in the clavipectoral triangle resulted; smaller volume of the contrast agent, shorter FT, and reduction in DAP, all of which were statistically significant (P < 0.0001).
Conclusions. Selective venography via a CV approach from the pocket of the implanted CIED is an effective alternative to the conventional peripheral contrast administration, and is potentially beneficial for the patients.