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Site of left axillary vein crossing the clavicle: an analysis with computed tomography venography as a guide for vein puncture for device implantation

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Abstract

Background

Blind axillary venous access is a convenient but technically difficult approach for cardiac rhythm device lead implantation. We try to explore whether there are rules on the axillary vein course to facilitate blind venous cannulation.

Methods

In a single-center, retrospective study, we included 155 patients who underwent computed tomography venography (CTV) examination of left axillary vein. All scans were reviewed for the relationship between left axillary vein and clavicle, vein steepness, and depth. Factors probably affecting above indicators were analyzed.

Results

The location of left axillary vein crossing the clavicle was mainly concentrated around the medial 1/3 of clavicle, with mean crossing location of the medial 1/3 of clavicle, which was not correlated with sex, age, abdominal subcutaneous fat thickness, upper thoracic kyphosis angle, or the angle between clavicle and anterior midline (P < 0.05). The average angle between axillary vein and horizontal line was 31.57 ± 11.72°, which was positively associated with age, whereas inversely associated with the angle between clavicle and anterior midline (P < 0.05). The proximal axillary vein ran more and more shallow until becoming the subclavian vein (P < 0.01); and it had a mean depth of 3 cm, which was significantly associated with abdominal subcutaneous fat thickness (P < 0.05).

Conclusions

The left axillary vein and clavicle had a relatively fixed relationship that axillary vein commonly crossed the medial 1/3 of clavicle. The average angle between axillary vein and horizontal line was 31.57 ± 11.72°, associated with age and the clavicle course. The mean depth of proximal axillary vein was 3 cm, and patients with larger weight had a deeper position of axillary vein.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by the National Natural Science Foundation of China (No. 82070523), Chongqing Science and Technology Bureau (No. cstc2019jscxmsxmX0307), and Chongqing Health Commission (No. 2020msxm113).

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Authors and Affiliations

  1. Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Jie Gao, Sen Lei & ChunChang Qin

  2. Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Yang Zhou

Authors
  1. Jie Gao
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  2. Yang Zhou
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  3. Sen Lei
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  4. ChunChang Qin
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Corresponding authors

Correspondence to Sen Lei or ChunChang Qin.

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Ethical approval

This study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University.

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Informed consent for the use of data without personally identifiable information was obtained by telephone from all subjects.

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The authors declare no competing interests.

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Jie Gao and Yang Zhou provided equal first-level contribution to the manuscript.

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Gao, J., Zhou, Y., Lei, S. et al. Site of left axillary vein crossing the clavicle: an analysis with computed tomography venography as a guide for vein puncture for device implantation. J Interv Card Electrophysiol 66, 1693–1700 (2023). https://doi.org/10.1007/s10840-023-01500-4

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  • DOI: https://doi.org/10.1007/s10840-023-01500-4

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