Supraclavicular Course of the Cephalic Vein

Introduction: Vascular access for transvenous pacemaker and cardioverter defibrillator implants is frequently obtained by using the cephalic cutdown technique. Sometimes anatomical variations may limit insertion of one or several leads. We describe a case of a patient with an anomalous supraclavicular course of the left cephalic vein. Case Report: A 61-year-old male with background of ischemic heart disease, hypertension, diabetes mellitus, obstructive sleep apnea and dyslipidemia, was referred to our institution after four months of recurrent syncopal episodes. A bradycardia-tachycardia syndrome was diagnosed and decided to proceed with permanent pacemaker implantation. Through a cutaneous incision in the left deltopectoral groove, we dissected the tissue planes until the left cephalic vein became visible. Fluoroscopy in anterior-posterior projection showed clear supraclavicular course of the cephalic vein. This access was abandoned by removing both wires and ligating the proximal end of the cephalic vein. Through a fluoroscopy/ venogram guided axillary puncture using the modified Seldinger technique and the retained wire technique, double central vein access was secured, allowing the passage of right atrial and ventricular leads. A dual chamber pacemaker was implanted. Conclusion: Although the supraclavicular course of the cephalic vein is a rare anatomical variant, it is important to recognize its presence as it may lead to potential complications related to lead dysfunction, erosion or collateral vascular damage if used as an access for permanent lead placement. Alternative central vein access is strongly recommended in such cases.

並列關鍵字

Pacemaker ； Implantable cardioverter-defibrillator ； Cephalic vein ； Implanted electrode

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