Scoring System Assessment of Cephalic Vein Access for Device Implantation
Journal
The Journal of Innovations in Cardiac Rhythm Management
Date Issued
2018-08
Author(s)
Janusevsi, Filip
Pocesta, Bekim
Boskov, Vladimir
Boyle G, Noel
DOI
10.19102/icrm.2018.090802
Abstract
The purpose of this study was to explore the usability of the cephalic vein (CV) for
cardiac implantable electronic device (CIED) lead access by applying a scoring system to assess
the venous anatomy. This prospective, single-center study included 100 consecutive patients
who underwent CIED implantation within a period of one year. Contrast-enhanced venography
images were obtained for every patient, focused on the CV, “T-junction,” and the subclavian/
axillary veins (SV/AVs). Though careful examination of the images, an angle, valves, diameter,
noncollateral (AVDnC) score was constructed and used to aid in choosing a CV or SV/AV access
approach; in all cases, however, the preferred approach was CV independent of the AVDnC score
result obtained. Upon use of the scoring system, the majority of patients (54%) had type A score
result ( 3), indicating a favorable anatomy for CV access. In 48 of these patients, the CV was
used for the implantation of at least one lead. The remaining 46 (46%) patients had type B score
result ( 2). In 41 patients from this group, SV/AV access was used for lead implantation and, in
five patients, CV access was used. The number of leads introduced through the CV was associated
with larger score and the operator’s experience. In conclusion, in more than 50% of patients, at
least one lead could be introduced through the CV. The scoring system used herein can simplify
the choice between CV and SV/AV access and could eventually increase the efficiency and safety of
the procedure, especially when less experienced implanters are involved.
cardiac implantable electronic device (CIED) lead access by applying a scoring system to assess
the venous anatomy. This prospective, single-center study included 100 consecutive patients
who underwent CIED implantation within a period of one year. Contrast-enhanced venography
images were obtained for every patient, focused on the CV, “T-junction,” and the subclavian/
axillary veins (SV/AVs). Though careful examination of the images, an angle, valves, diameter,
noncollateral (AVDnC) score was constructed and used to aid in choosing a CV or SV/AV access
approach; in all cases, however, the preferred approach was CV independent of the AVDnC score
result obtained. Upon use of the scoring system, the majority of patients (54%) had type A score
result ( 3), indicating a favorable anatomy for CV access. In 48 of these patients, the CV was
used for the implantation of at least one lead. The remaining 46 (46%) patients had type B score
result ( 2). In 41 patients from this group, SV/AV access was used for lead implantation and, in
five patients, CV access was used. The number of leads introduced through the CV was associated
with larger score and the operator’s experience. In conclusion, in more than 50% of patients, at
least one lead could be introduced through the CV. The scoring system used herein can simplify
the choice between CV and SV/AV access and could eventually increase the efficiency and safety of
the procedure, especially when less experienced implanters are involved.
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