Utility of Caudal Angulation for Venous Access under Fluoroscopic Guidance during Cardiovascular Implantable Electronic Device Implantation.
CIED
Caudal fluoroscopy
Venous access
Journal
Cardiology
ISSN: 1421-9751
Titre abrégé: Cardiology
Pays: Switzerland
ID NLM: 1266406
Informations de publication
Date de publication:
Historique:
received:
24
09
2020
accepted:
15
02
2021
pubmed:
14
4
2021
medline:
1
9
2021
entrez:
13
4
2021
Statut:
ppublish
Résumé
Axillary venous access is preferred for CIED implantation. The procedure is usually performed under fluoroscopic guidance in anteroposterior (A-P) view. However, there is a lack of perception of depth in this view with a fear of creating complications. Caudal fluoroscopy (adding 30°-35° caudal angulation to A-P projection) has been proposed to circumvent this problem. The aim of this study was to elucidate the advantages of caudal fluoroscopy using fluoroscopic images, contrast venograms, and CT angiography images of axillary vein. The fluoroscopic images and contrast venograms obtained in the A-P view were compared with caudal fluoroscopy in patients undergoing CIED implantation at our centre. Also, the CT angiography images of axillary vein were reconstructed to understand the relative anatomy of the vein and the underlying lung parenchyma, simulating these 2 projections. The CT angiography images, contrast venograms, and fluoroscopic images confirmed that caudal fluoroscopy allows better visualization of the vein in relation to the lung parenchyma and rib cage. Analysis of fluoroscopic images revealed that the bend of the first rib formed a conical prominence in caudal fluoroscopy. This served as an important bony landmark for successful venous access, which was usually obtained while the needle was being directed towards this prominence in caudal fluoroscopy. The proposed advantages of caudal fluoroscopy for CIED implantation have been elucidated by analysis of CT angiography images, contrast venograms, and fluoroscopic images.
Sections du résumé
BACKGROUND
BACKGROUND
Axillary venous access is preferred for CIED implantation. The procedure is usually performed under fluoroscopic guidance in anteroposterior (A-P) view. However, there is a lack of perception of depth in this view with a fear of creating complications. Caudal fluoroscopy (adding 30°-35° caudal angulation to A-P projection) has been proposed to circumvent this problem.
OBJECTIVE
OBJECTIVE
The aim of this study was to elucidate the advantages of caudal fluoroscopy using fluoroscopic images, contrast venograms, and CT angiography images of axillary vein.
METHODS
METHODS
The fluoroscopic images and contrast venograms obtained in the A-P view were compared with caudal fluoroscopy in patients undergoing CIED implantation at our centre. Also, the CT angiography images of axillary vein were reconstructed to understand the relative anatomy of the vein and the underlying lung parenchyma, simulating these 2 projections.
RESULTS
RESULTS
The CT angiography images, contrast venograms, and fluoroscopic images confirmed that caudal fluoroscopy allows better visualization of the vein in relation to the lung parenchyma and rib cage. Analysis of fluoroscopic images revealed that the bend of the first rib formed a conical prominence in caudal fluoroscopy. This served as an important bony landmark for successful venous access, which was usually obtained while the needle was being directed towards this prominence in caudal fluoroscopy.
CONCLUSIONS
CONCLUSIONS
The proposed advantages of caudal fluoroscopy for CIED implantation have been elucidated by analysis of CT angiography images, contrast venograms, and fluoroscopic images.
Identifiants
pubmed: 33849016
pii: 000515360
doi: 10.1159/000515360
doi:
Types de publication
News
Langues
eng
Sous-ensembles de citation
IM
Pagination
464-468Informations de copyright
© 2021 S. Karger AG, Basel.