The Efficacy of the Combination of Preoperative Venography and Cephalic Vein Direct Cutdown Procedure to Insert 2 Leads into the Cephalic Vein

概要

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We began to implant DDD pacemaker with cephalic vein direct puncture procedure in 2004. We could inset two leads from the cephalic vein even if it was quite narrow. However, there was sometimes to change into the puncture techinique because a vein was occuluded. Then the success rate was 83% (25/30). Therefore, we attempted to evaluate the cephalic vein by preoperative venography. Since then, in the consecutive 156 DDD pacemaker cases, 2 leads could be inserted into the cephalic vein in 154 cases (98.7%). In 25 cases of these 154 cases, we changed the operation site from the left breast to the right breast because of detecting the occulusion of the left cephalic vein by the preoperative venography. In 2 failure cases as a cutdown procedure, we did choose the puncture techinique from the beginning because of the occulusion of both cephalic veins. We have no complications which may occur in puncture method as follows: pneumothorax, hemothorax, and lead fructure and so on. <B>Conclusions:</B> When operating in cephali vein direct puncture procedure and preoperative venography, two leads can have been approximately surely inserted to the cephalic vein. It is convinced that this way is useful for the pacemaker implantation.