Prospective study of axillary vein puncture with or without contrast venography for pacemaker and defibrillator lead implantation

Pacing Clin Electrophysiol. 2005 Jan;28 Suppl 1:S280-3. doi: 10.1111/j.1540-8159.2005.00039.x.


Axillary vein puncture may be used to implant pacemaker (PM) or cardioverter defibrillator leads, though usually requires venography. We prospectively compared punctures guided by venography versus a new radiological landmark. In 232 patients, the puncture was guided by injecting diluted contrast material via an ipsilateral peripheral vein (group A, n = 142), or without venography using the intersection of the lateral borders of the second and third rib as a radiological landmark, followed by contrast injection in case of failure (group B, n = 90). We implantated 1-3 leads per patient. In group A, implantation was successful in 135 patients (95%) and in group B in 55 patients (61%, P < 0.001 vs group A). Subsequent contrast injection allowed successful implantations in 34 of 35 patients, with an success rate of 97% for the overall study population of 224 patients. Venous access was achieved after a mean of 10.4 +/- 3.2 minutes of skin incision in group A versus 9.4 +/- 3.0 minutes in group B (ns). Pneumothorax occurred in two patients (1% overall). Thus non-contrast guided puncture using a new radiological landmark was successful in a majority of patients. This technique may be useful in absence of ipsilateral peripheral vein access, or presence of contrast allergy.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Axillary Vein*
  • Contrast Media*
  • Defibrillators, Implantable*
  • Female
  • Fluoroscopy
  • Humans
  • Male
  • Pacemaker, Artificial*
  • Phlebography / methods*
  • Prospective Studies
  • Prosthesis Implantation / methods*
  • Punctures*


  • Contrast Media