Pre-Procedure Duplex Ultrasonography to Assist Cephalic Vein Isolation in Pacemaker and Defibrillator Implantation

  • Jan-Yow Chen
  • Kuan-Cheng ChangEmail author
  • Yu-Chin Lin
  • Hsiang-Tai Chou
  • Jui-Sung Hung


Background: Difficulty in isolating the cephalic vein contributes to failed pacemaker and intracardiac cardioverter-defibrillator (ICD) implantation via the cephalic venous approach. The deltopectoral groove is used as a rough landmark, but the vein is often not found here. We evaluated the benefit of pre-procedural duplex ultrasonography in isolating the cephalic vein.

Methods: We enrolled 80 consecutive patients undergoing new pacemaker or defibrillator implantation and performed duplex ultrasonography to localize the cephalic vein before implantation. The corresponding surface location in the infraclavicular region and the depth of the cephalic vein were identified and recorded if the vein was well visualized. Using the imaging results, we dissected the skin over the predicted location until the cephalic vein was isolated. We determined the depth and corresponding surface location of the proximal cephalic vein during surgery. Afterward, we compared localization of the vein using imaging, surgery, and the deltopectoral-groove method. The relationship between cephalic vein depth and body parameters was also evaluated after the procedure.

Results: All proximal cephalic veins were successfully isolated under the assistance of pre-procedural duplex ultrasonography. When the corresponding surface locations were compared, the location depicted on sonograms was closer to the surgical finding than the location determined by using the deltopectoral-groove method (0.5 ± 3.9 vs. 4.9 ± 9.6 mm; P < .001). The depth of the cephalic vein derived from duplex sonograms showed excellent correlation with the surgical findings (r = 0.93, P < 0.001). The cephalic vein depth and body mass index (BMI) also showed a linear relationship with good correlation (r = 0.70, P < 0.001).

Conclusion: Pre-procedural duplex ultrasonography helped in localizing the proximal cephalic vein and isolating the cephalic vein. Surface localization of the proximal cephalic vein was superior with sonography than with the deltopectoral-groove method. There was a linear relationship with good correlation between BMI and cephalic vein depth.

Key Words

cephalic vein duplex ultrasonography deltopectoral groove pacemaker defibrillator body mass index 


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  1. 1.
    Littleford PO, Parsonnet V, Specor SD. Method for the rapid and atraumatic insertion of permanent endocardial pacemaker electrodes through the subclavian vein. Am J Cardiol 1979;43:980–982.CrossRefGoogle Scholar
  2. 2.
    Furman S. Venous cutdown for pacemaker implantation. Ann Thorac Surg 1986;41:438–439.Google Scholar
  3. 3.
    Parsonnet V, Roelke M. The cephalic vein cutdown versus subclavian puncture for pacemaker/ICD lead implantation. Pacing Clin Electrophysiol 1999;22:695–697.Google Scholar
  4. 4.
    Knight BP, Curlett K, Oral H, Pelosi F, Morady F, Strickberger SA. Clinical predictors of successful cephalic vein access for implantation of endocardial leads. J Interv Card Electrophysiol 2002;7:177–180.CrossRefGoogle Scholar
  5. 5.
    Tse HF, Lau CP, Leung SK. A cephalic vein cutdown and venography technique to facilitate pacemaker and defibrillator lead implantation. Pacing Clin Electrophysiol 2001;24:496–473.CrossRefGoogle Scholar
  6. 6.
    De Rosa F, Talarico A, Mancuso P, Plastina F. New introducer technique for implanting pacemakers and defibrillator leads: Percutaneous incannulaion of the cephalic vein. G Ital Cardiol 1998;28:1094–1098.Google Scholar
  7. 7.
    Shimada H, Hoshino K, Yuki M, Sakurai S, Owa M. Percutaneous cephalic vein approach for permanent pacemaker implantation. Pacing Clin Electrophysiol 1999;22:1499–1501.Google Scholar
  8. 8.
    Ong LS, Barold SS, Lederman M, Falkoff MD, Heinle RA. Cephalic vein guide wire technique for implantation of permanent pacemakers. Am Heart J 1987;114:753–756.CrossRefGoogle Scholar
  9. 9.
    Dwivedi SK, Narain VS, Dhawan S, Dhawan S, Soni D, Hasan M. Modified cephalic vein guide wire technique for permanent pacemaker implantation. Indian Heart J 1992;44:87–89.Google Scholar
  10. 10.
    Ascher E, Hingoran A, Gunduz Y, Yorkovich Y, Ward M, Miranda J, Tsemekhin B, Kleniner M, Greenberg S. The value and limitations of the arm cephalic and basilic vein for arteriovenous access. Ann Vasc Surg 2001;15:89–97.CrossRefGoogle Scholar
  11. 11.
    Sivanesan S, How TV, Barkran A. Sites of stenosis in AV fistulae for hemodialysis access. Nephrol Dial Transplant 1999;14:118–120.CrossRefGoogle Scholar
  12. 12.
    Huber TS, Ozaki CK, Flynn TC, Flynn TC, Lee WA, Berceli SA, Hirneise CM, Carlton LM, Carter JW, Ross EA, Seeger JM. Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access. J Vasc Surg 2002;36:452–459.CrossRefGoogle Scholar
  13. 13.
    Luciani A, Clement O, Halimi P, Goudot D, Portier F, Bassot V, Luciani J-A, Avan P, Frija G, Bonfils P. Catheter-related upper extremity deep venous thrombosis in cancer patients: A prospective study based on Doppler US. Radiology 2001;220:655–660.Google Scholar
  14. 14.
    Killewich LA, Bedford GR, Beach KW, Strandness DE Jr. Diagnosis of deep vein thrombosis. A prospective study comparing duplex scanning to contrast venography. Circulation 1989;79:810–814.Google Scholar
  15. 15.
    Chen JY, Chang KC, Lin YC, Chou HT, Hung JS. Safety and outcome of short-term multiple femoral venous sheath placement in cardiac electrophysiological study and radiofrequency catheter ablation. Jpn Heart J 2004;45:257–264.CrossRefGoogle Scholar
  16. 16.
    Joynt GM, Kew J, Gomersall CD, Leung VY, Liu EK. Deep vein thrombosis caused by femoral venous catheters in critically ill adult patients. Chest 2000; 117:178–183.CrossRefGoogle Scholar
  17. 17.
    Hughes P, Scott C, Bodenham A. Ultrasonography of the femoral vessels in the groin: Implications for vascular access. Anaesthesia 2000;55:1192–1212.CrossRefGoogle Scholar
  18. 18.
    Comerota AJ, Katz ML, Hashemi HA. Venous duplex imaging for the diagnosis of acute deep venous thrombosis. Haemostasis 1993;23(Suppl):61–71.Google Scholar
  19. 19.
    ML. The role of sonography in the placement and management of jugular and subclavian central venous catheters. Am J Roentgenol 163:291–295.Google Scholar
  20. 20.
    Gualtieri E, Deppe SA, Sipperly ME, Thompson DR. Subclavian venous catheterization: Greater success rate for less experienced operators using ultrasound guidance. Crit Care Med 1995;23:692–697.CrossRefGoogle Scholar
  21. 21.
    Chen JC, Chang KC, Lin YC, Chou HT, Hung JS. Feasibility and accuracy of pre-procedure imaging of the proximal cephalic vein duplex ultrasonography in pacemaker and defibrillator implantation. J Interv Card Electrophysiol 2004;10:31–35.CrossRefGoogle Scholar
  22. 22.
    Pejovic-Milic A, Brito JA, Gyorffy J, Chettle DR. Ultrasound measurements of overlying soft tissue thickness at four skeletal sites suitable for in vivo x-ray fluorescence. Med Phys 2002;29:2687–2691.CrossRefGoogle Scholar
  23. 23.
    Sabir N, Pakdemirli E, Sermez Y, Zencir M, Kazil S. Sonographic assessment of changes in thickness of different abdominal fat layers in response to diet in obese women. J Clin Ultrasound 2003;31:26–30.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Jan-Yow Chen
    • 1
  • Kuan-Cheng Chang
    • 1
    • 2
    Email author
  • Yu-Chin Lin
    • 1
  • Hsiang-Tai Chou
    • 1
  • Jui-Sung Hung
    • 1
  1. 1.Division of Cardiology, Department of MedicineChina Medical University HospitalTaichungTaiwan
  2. 2.Division of Cardiology, Department of MedicineChina Medical University HospitalTaichungTaiwan

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