Novel Technique to Facilitate Defibrillator Lead Implantation via Cephalic Vein Cutdown by Means of a Reference Catheter and a Specially Designed Long Sheath

The cephalic vein is recommended as the access route for an implantable cardioverter defibrillator lead to avoid complications associated with subclavian vein puncture; however, cephalic vein cutdown is not necessarily preferred, mainly because of procedural complexity. To facilitate cephalic vein cutdown, we have devised the following method. An 8 Fr catheter is placed in the cephalic vein over a guidewire inserted percutaneously from the left peripheral cephalic vein. The catheter, which is palpable beneath the skin prior to incision, indicates the location of the cephalic vein, facilitating its isolation. A specially designed 9 Fr tear-away sheath-dilator unit is used to place leads. With its long-tapered and curved tip, the unit is easy to insert, even when the cephalic vein is stenotic or tortuous. The 30-cm-long sheath reaches the right atrium, and thus the lead is advanced directly to the right atrium without risk of vascular injury. This technique may be feasible in the majority of patients and can even be used by inexperienced implanters.

Abstract licence: CC BY-NC

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