Central venous puncture versus cutdown for permanent pacemaker lead insertion: A modified double introducer technique

Objective. The comparative safety of central venous puncture versus cutdown technique for access to the right heart. Experimental design. A retrospective review of five hundred and fifty-five single and dual chamber permanent pacemaker implants performed between January of 1987 and December of 1993. Setting. Review was performed at St. Vincent's Hospital in New York, New York and its teaching affiliate, Huntington Hospital, Huntington, New York. Results. A total of 310 venous punctures were performed. The complication rate was 3.5% overall, with one procedure related death (0.3%) from major venous laceration; a stiff 14 French dilator sheath was employed in this case. There were no comparable complications in the 245 lead placements performed by various cutdown methods. Conclusion. Venous cutdown is a safe and effective method for placement of single and dual chamber pacemaker leads. If unsuccessful, the cephalic vein guidewire and double introducer techniques may be employed to rule out placement of dual chamber leads through a hypoplastic cephalic vein, using introducers not larger than 10 French. In properly selected patients, this technique could potentially prevent the complications associated with venous puncture.