Analysis Of Pacemaker Electrode Implanted Through Distal Segment Puncture Of Axillary Vein

Research background:With the rapid aging of China’s population and the increase of the average age of citizens,the clinical use of implantable permanent cardiac pacemakers,is also increasing.Whether permanent pacemaker implantation or electrode resetting,successful venipuncture placement of the electrode is a critical step in pacemaker implantation.In recent years,the proximal axillary vein has been favored by clinicians due to its large internal diameter,distance from the pleura,and large distance between arteries and veins.However,we found that there was still a risk of pneumothorax in clinical ascending axillary vein proximal puncture.At that time,the proximal axillary vein was selected as the puncture point rather than the distal axillary vein,which was further away from the pleura,mainly because the distal axillary vein had a smaller internal diameter and the medial and lateral roots of the median nerve ran along the inner and outer sides.However,at present,the clinical data of inner diameter measurement of the proximal and distal axillary vein were all obtained from cadavers.We believe that the measurement of inner diameter of the superior vessels of cadavers is not completely consistent with that of human beings.Objective:The proximal and distal end of the axillary vein was defined according to the axillary vein route and the X-ray image of the axillary vein.DSA(digital subtraction angiography)was used to measure the proximal distal axillary vein and the inner diameter of subclavian vein in upper segment of human body.Venography was used topuncture the proximal and distal end of the axillary vein to compare the success rate and complication rate of the two groups,and to explore the safety and feasibility of pacemaker electrode implantation by puncture at the distal end of the axillary vein.Methods:From march 1,2019 to January 31,2020,108 patients who received permanent pacemaker implantation in the cardiac catheterization room of the first hospital of ShanXi Medical University were selected.The patients were randomly divided into the distal axillary vein group and the proximal axillary vein group.The inner diameter of the proximal axillary vein and the subclavian vein were measured by DSA segmentation.The proximal distal axillary vein and the inner diameter of subclavian vein were compared by statistical methods,and the effects of gender,BMI and hypertension on the inner diameter of the vessels were analyzed.The success rate,complication rate and puncture time of the two groups were compared.Results:DSA was used to measure the inner diameter of the proximal axillary vein and subclavian vein.The distal axillary vein,the proximal axillary vein and the subclavian vein were tested by t test respectively,all P < 0.05,showing statistical differences.T test was performed on the proximal axillary vein and subclavian vein,respectively,and there was no statistical difference at P > 0.05.Among the 54 patients in the distal axillary vein group,30(55.6%)were successful in the first puncture,12(22.2%)were successful in the second puncture,and 50(92.6%)were successful in the total puncture.The average puncture time was 108.12± 28.86 s,and the average number of puncture was 2.28±1.10.Among the 54 patients in the proximal axillary vein group,32(59.3%)were successful in the first puncture,14(25.9%)in the second puncture,and 52(96.3%)in the total,with an average puncture time of 109.83± 29.83 s and an average puncture times of2.15 ±1.00.There was no statistically significant difference between the two groups in thesuccess rate,total success rate and time consuming of first-needle puncture,P > 0.05.In the distal axillary vein group,4 patients failed to be punctured for 5min and successfully changed to subclavian vein puncture.One patient strayed into the artery(1.85%),and one patient(1.85%)had cystic hematoma.In the proximal axillary vein group,2 patients had unsuccessful puncture and successfully changed to subclavian vein puncture,1 patient had strayed into the artery(1.85%),1 patient(1.85%)developed pneumothorax and self-absorption improved.There was no significant difference in the incidence of complications between the two groups(P > 0.05).Conclusion:There were statistical differences between the distal axillary vein and the proximal axillary vein and the subclavian vein(P < 0.05).However,the distal diameter of the axillary vein is large enough to carry multiple cardiac pacing electrodes,and it completely goes outside the chest,far away from the pleura,which can reduce the risk of pneumothorax.