Predictors of axillary vein location for vascular access during pacemaker and defibrillator lead implantation

Pacing Clin Electrophysiol. 2011 Dec;34(12):1585-92. doi: 10.1111/j.1540-8159.2011.03191.x. Epub 2011 Aug 7.


Background: The axillary vein is a commonly used extrathoracic access site for cardiac rhythm device lead implantation. We sought to describe variation in axillary vein location and identify predictors of a more cranial or caudal radiographic location to facilitate blind venous cannulation.

Methods: This was a single-center, retrospective study of patients undergoing lead implantation between 2006 and 2010. The cranial-caudal location of the axillary vein lateral and medial to the rib cage border was determined by reviewing peripheral contrast venograms. Multivariate linear regression was performed.

Results: Of 155 patients, the majority were men (62%) and White (53%). The most frequent position of the lateral and medial axillary vein was over the third rib (40%) and top of the third rib (15%), respectively. In multivariate analysis, whites had a more caudal location of both the lateral (0.56 rib spaces lower, 95% confidence interval [CI] 0.22-0.91, P = 0.002) and medial axillary vein (0.50 rib spaces lower, 95% CI 0.85-0.91, P = 0.019). Other independent predictors included an approximate 3-4% higher rib space location for every digit increase in body mass index (BMI) (P = 0.049 for the lateral location and P = 0.016 for the medial location) and an approximate half rib space higher location for males (P = 0.015 for the lateral location and P = 0.013 for the medial location).

Conclusions: The most common radiographic position of the axillary vein was over the third rib. Whites have a more caudal axillary vein location while men and patients with higher BMI have a more cranial position of the axillary vein.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Axillary Vein / diagnostic imaging*
  • Defibrillators*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial*
  • Phlebography
  • Prosthesis Implantation / methods*
  • Retrospective Studies
  • Ribs / anatomy & histology
  • Ribs / blood supply
  • Ribs / diagnostic imaging