Three different kinds of approaches to percutaneous venipuncture to axillary vein for implanting permanent pacemaker electrods in 72 patients

Objectives To evaluate the safety and utility of three different kinds of venipuncture to axillary vein for permanent pacemaker implantation.Methods In 72 patients pacing leaders were implanted with the techniques,including 16 patients with intravenous injection of contrast agent to locating the axillary vein,18 patients with venipuncture through cubital vein introducing guide wire to superior vena cava,pucturing axillary vein directed by the guide wire under X ray,38 patients punctured by the mark between clavicle and first rib under X ray(a line extending inclined up 10 degree from the middle point in sternoclavicular joint crossing first rib,the crossing point was the one that needle entered into the vein).72 patients with the method of percutaneous venipuncture to subclavian vein as control group.Results All venipunctures to axillary vein were successful in 72 patients,the times and the time consuming of venipuncture were similar to the control(all P0.05).The easiest way was the one guided by contrast agent locating the axillary vein,average puncture time was 1.2 min,the next was guide wire way,average puncture time was 2.7 min,then the way according the mark between clavicle and first rib under X ray,average puncture time was 3.5 min.Conclusion The way of puncture into the axillary vein is easier by contrast agent or guide wire locating the axillary vein,but more complex.The methods of puncture axillary vein under X ray is safe and reliable with high successful rate and avoiding of defects or complications of puncturing subclavian vein,appropriating for all pacemaker leaders.The way of guide wire or contrast agent locating axillary vein is expense and potential hazard to patients,though with high successful rate.