ANATOMICAL MECHANISMS EXPLAINING DAMAGE TO PACEMAKER LEADS, DEFIBRILLATOR LEADS, AND FAILURE OF CENTRAL VENOUS CATHETERS ADJACENT TO THE STERNOCLAVICULAR JOINT
ANATOMICAL MECHANISMS EXPLAINING DAMAGE TO PACEMAKER LEADS, DEFIBRILLATOR LEADS, AND FAILURE OF CENTRAL VENOUS CATHETERS ADJACENT TO THE STERNOCLAVICULAR JOINT
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DOI：
10.1111/j.1540-8159.1993.tb01607.x
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发表时间：
1993-03-01
影响因子：
1.8
通讯作者：
HUNTER, DW
中科院分区：
文献类型：
--
作者：
MAGNEY, JE;FLYNN, DM;HUNTER, DW
文献表明，大约93%的起搏器电极导线断裂发生在静脉入口外侧的电极导线节段中，并且涉及肋锁压缩。虽然锁骨的运动可能会压迫血管，但我们的研究表明，该区域的电极导线和导管损伤是由软组织卡压而不是骨接触引起的。对8具尸体的10根电极导线进行解剖，发现2根电极导线进入头静脉，未纳入研究。在其他8根电极导线中，4根穿过锁骨下肌，2根穿过肋锁韧带，2根穿过这两个结构，然后进入锁骨下静脉、颈内静脉或头臂静脉。解剖学研究表明，锁骨下肌或肋锁韧带的卡压可能导致胸带运动期间电极导线反复弯曲。位置依赖性导管闭塞患者的影像学证实了锁骨下肌的卡压。软组织截留会对电极导线和导管施加静载荷，截留点周围的反复弯曲可能是先前归因于循环性肋锁压缩的损伤的原因。
The literature suggests that approximately 93% of all pacemaker lead fractures occur in the segment of the lead lateral to the venous entry, and costoclavicular compression has been implicated. While blood vessels can be compressed by movements of the clavicle, our research suggests that lead and catheter damage in that region is caused by soft tissue entrapment rather than bony contact. Dissection of eight cadavers with ten leads revealed that two entered the cephalic vein, and were not included in the study. Of the other eight leads, four passed through the subclavius muscle, two through the costoclavicular ligament, and two through both these structures before entering the subclavian, internal jugular, or brachiocephalic vein. Anatomical studies demonstrated that entrapment by the subclavius muscle or the costoclavicular ligament could cause repeated flexing of leads during movements of the pectoral girdle. Cineradiology of patients with position dependent catheter occlusion confirmed entrapment by the subclavius muscle. Soft tissue entrapment imposes a static load upon leads and catheters, and repeated flexure about the point of entrapment may be responsible for damage previously attributed to cyclic costoclavicular compression.