Usefulness of Venous Puncture on Cross-Site of Subclavicular Vein and 1st Costa by Contrasting in 30 Degree Oblique View

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Aim: We examined usefulness of venous puncture on cross-site of subclavicular vein and 1st costa by contrasting in 30 degree oblique view (SC30), that we originally designed. Objects and Methods: The objects are 67 patients received with DDD pacemaker implantation from January 2006 to May 2011. We compared puncture-time, success rate of anatomical extrathoracic puncture and complications of SC30, with those of the other puncture methods. Results: The patients divided into 13 of blind puncture (BP), 30 of double marker methods (DM), 15 of puncture guided by contrasting in frontal view (FC) and 9 of SC30 group. Mean-puncture time were BP: 58±19, DM: 43±18, FC: 36±11, SC30: 24±7 min, respectively. Punctures of SC30 were performed significantly more rapidly than that of BP (p<0.001), DM (p<0.001) and FC (p<0.01). Extrathoracic puncture is performed 2 of 13BP (p<0.001 vs SC30), 26 of 30DM (ns vs SC30), 9 of 15FC (ns vs SC30) and all of SC30 respectively. Lead dislodge is seen 5 of DM, 1 of FC and 1 of SC30. V-lead perforation is seen in 1 of BP. There were no case of infection and pneumothorax. Discussion: SC30 could be performed rapidly with high success rate of extrathoracic puncture and rare complications. Conclusion: We could recommend SC30 as the first line method of venous puncture in DDD implantation.