Supraclavicular course of the cephalic vein
Supraclavicular course of the cephalic vein
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头静脉锁骨上走行
DOI：
10.5348/ijcri-201458-cr-10369
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Francisco Villegas
中科院分区：
文献类型：
--
作者：
J. Ramírez;L. Saenz;Diego Rodríguez;A. Restrepo;Francisco Villegas
简介：经静脉起搏器和心律转复除颤器植入的血管通道通常是通过使用头侧切割技术获得的。有时解剖变异会限制一根或几根导线的插入。我们描述了一个病例的病人与一个异常的锁骨上过程的左头静脉。病例报告：一名61岁男性，患有缺血性心脏病、高血压、糖尿病、阻塞性睡眠呼吸暂停和血脂异常，因反复晕厥发作4个月后转介至我院。诊断为心动过缓综合征，并决定进行永久性起搏器植入。通过左三角胸肌沟的皮肤切口，我们解剖了组织平面，直到看到左头静脉。前后投影透视显示清晰的头静脉锁骨上路线。通过拆除两根导线并结扎头静脉近端，放弃了这种通路。采用改进的Seldinger技术和保留导线技术，通过透视/静脉造影引导腋窝穿刺，确保双中心静脉通路，允许右心房和心室导联通过。植入双室起搏器。结论：尽管锁骨上头静脉是一种罕见的解剖变异，但重要的是要认识到它的存在，因为它可能导致潜在的并发症，如铅功能障碍，侵蚀或侧支血管损伤，如果作为永久放置铅的通道。在这种情况下，强烈建议采用其他中心静脉通路。
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.