| Objective: Cardiac intervention therapy, such as cardiac electrophysio-logical study, radiofrequency catheter ablation and pacemaker implantation,has been proven to be a safe and effective method for diagnosis and treatmentof various arrhythmias, and has been widely used in clinic. Subclavian veinwas the most commonly used puncture pathway, with the extensivedevelopment and application of pacemaker technology, double chamberpacemaker, three chamber pacemaker has been widely implanted into patients,and most of electrodes are embedded through the subclavian vein. Currently,most of pacemaker electrodes are thicker and rigid bipolar electrodes, leadingto the increasing incidence of subclavian vein crush syndrome. The puncturepathway of axillary vein is an effective method to solve the "crush", and caneffectively avoid various complications, such as pneumothorax. In order tolocate the landmark of axillary venous, we plan to evaluate angiography of theaxillary vein pathway by median cubital vein or cephalic vein puncture.Subjects:115patients aged15-88years old of both sexes were enrolledinto this study between March2012and December2013at the SecondHospital of Hebei Medical University, including59patients with paroxysmalsupraventricular tachycardia for radiofrequency catheter ablation (RFCA),56patients with sick sinus syndrome, atrioventricular block, malignantarrhythmia, heart failure for pacemaker implantation (including singlechamber pacemaker, double chamber pacemaker, ICD, CRT).56cases wasmale,59cases was female.Methods: The patients who were supine with their upper limbs saggingnaturally on both sides of the body were punctured through median cubitalvein or cephalic vein and pushed iodine amine injection (370) about5ml foraxillary vein angiography using digital subtraction angiography X-raymachine（DSA）. Clavicle shape（the angle between clavicle and horizontal line）is observed under X-ray fluoroscopy. After developed，the shape ofaxillary vein is investigated and several indicators should be measured withthe Archive Manager image processing soft: the angle between clavicle andhorizontal line, the angle between axillary vein and clavicle, the distancebetween axillary vein starting and the sternal end of clavicle. Then, in thechest area，the nadir of left subclavian right-angled triangle formed by thesurface of the skin sag was point A，under vertical about1.2cm was point Bas the landmark of axillary vein (see Fig.1). In order to the point B can bedeveloped under X-ray, We adopt the electrode as the surface mark.Electrodes are marked at the point B，then the passing rate of axillary vein areobserved through landmark of body, and we analyze whether there issignificant difference between different gender and clavicle type.Statistical analysis: All data were represented as mean±SD or percent-age. All the statistical examinations were performed using either independentsamples t-test or Chi-squared test by SPSS13.0software. The correlationanalysis between two variables used rectilinear correlation. P<0.05wasconsidered statistically significant.Results: The average age was57.00±15.82years old (15～78years old)in115cases, including56males (48.70%) and59females(51.30%).The number of patients with implantation of RFCA was59cases (51.30%).The number of patients who have pacemaker implantation was56cases(48.70%). The number of patients who were made by axillary veinangiography on the left side of body was76cases (66.09%), The number ofpatients who were made by axillary vein angiography on the right side of bodywas39cases (33.91%). No complications occurred. The data showed that theangle between the clavicle and the horizontal line was29.74±7.48°on average,of which less than30°was56cases (48.70%) with23.30±4.44°on average, ofwhich30.1°~45°was59cases(51.30%) with35.90±3.64°on average. Theangle between the clavicle and the horizontal line was30.70±7.38°on averagein male,28.83±7.53°on average in female,29.50±7.48°on average on the leftside and30.23±7.57°on average on the right side. Both different side and different gender, the comparison of angle between clavicle and the horizontalline showed no significant difference (P>0.05). The angle between axillaryvein and clavicle was57.30±10.50°on average. The comparison of angle hada significant difference between male and female (60.00±11.47°vs.54.80±8.86°, P<0.05). The comparison of angle had no significant differencebetween left and right (58.12±10.64°vs.55.71±10.17°, P>0.05). There were arectilinear correlation between the angle of the clavicle and the horizontal lineand the angle of the axillary vein and the clavicle(r＝0.373P<0.05). Thedistance between axillary vein starting and the sternal end of clavicle was54.74±11.10mm on average. The distance is significantly different betweenmale and female (57.86±9.15mm vs.51.77±12.02mm, P<0.05), while therewas no significant difference between left and right (55.50±11.54mmvs.53.24±10.15mm, P>0.05). There was no rectilinear correlation between theangle of the clavicle and the horizontal line and the distance of the axillaryvein starting and the sternal end of clavicle (P>0.05). After analyzing the dataof the angle between the clavicle and the horizontal line, we found that therewas no difference in different gender and body side. So the axillary vein wasin different body side. We made axillary vein angiography all at the left side.The number of patients who were marked with electrodes, then, we madeaxillary vein angiography at the left side was21cases,of which less than30°were14cases (66.67%), of which30.1°~45°were7cases (33.33%), of whichmale were12cases(57.14%), female were9cases (42.86%). The number ofpatients whose axillary vein passing the landmark was17cases, of which theclavicle and the horizontal line angle less than30°were11cases, of which30.1°to45°were a total of6cases including7female（41.18%）and10male（58.82%）. The total passing rate was80.95%. The comparison of the rate ofpassing the landmark between different gender and clavicle type showed nosignificant difference.Conclusion: In this study, we found that the body surface mark of theaxillary vein puncture was relatively fixed. Marked by clavicle, the distancebetween axillary vein starting and clavicle medial head was54.74±11.10mm on average, the angle between clavicle and axillary vein was57.30±10.50°onaverage. Majority of patients’ axillary vein pass the point B (the comparisonof the rate of passing the body surface maker between different gender andclavicle type was no significant difference). There was a significant differencebetween different gender, while different side of the body had no statisticaldifference. There was a rectilinear correlation between the angle of theclavicle and the horizontal line and the angle of the axillary vein and theclavicle. |
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