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Europace 2019 Jan;21(1):121-129

Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.

Aims: Cephalic vein cutdown (CVC) and subclavian puncture (SP) are widely used techniques for lead insertion of cardiac implantable electronic devices (CIEDs). Whether one technique is superior to the other, is still being debated. The purpose of this study was to compare CVC vs. Read More

Am Surg 2018 Jun;84(6):841-843

The request for totally implantable venous access devices (TIVADs) has rapidly grown up through the last decades. TIVADs are implanted by direct vein puncture or by surgical approach with vein cutdown. The authors present a comparative prospective study evaluating external jugular vein (EJV) and cephalic vein cutdown techniques. Read More

Indian Pacing Electrophysiol J 2018 Jul - Aug;18(4):152-154. Epub 2018 Apr 13.

Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan.

The cutdown technique for the cephalic vein is a common access route for transvenous cardiac device leads (TVLs), and sometimes one cephalic vein can accomodate two TVLs. We examined a novel ligation technique to balance the hemostasis and lead maneuverability for this two-in-one insertion. A total of 22 patients scheduled for cardiac device implantations with two or more leads were enrolled. Read More

Folia Morphol (Warsz) 2018 18;77(3):464-470. Epub 2018 Jan 18.

Department of Cardiology, Medical University of Warsaw, Poland, Banacha 1a, Warsaw, Poland.

Background: During cardiac implantable electronic device (CIED) implantation procedures cardiac leads have been mostly introduced transvenously. The associated injury to the selected vessel and adjacent tissues may induce reflex vasoconstriction. The aim of the study was to assess the incidence of cephalic vein (CV) vasoconstriction during first-time CIED implantation. Read More

Am Surg 2017 Dec;83(12):1336-1342

The superiority of surgical cut-down of the cephalic vein versus percutaneous catheterization of the subclavian vein for the insertion of totally implantable venous access devices (TIVADs) is debated. To compare the safety and efficacy of surgical cut-down versus percutaneous placement of TIVADs. This is a single-institution retrospective cohort study of oncologic patients who had TIVADs implanted by 14 surgeons. Read More

J Invasive Cardiol 2017 Dec;29(12):E184-E189

Director of Electrophysiology, NYU Winthrop Hospital, 212 Jericho Turnpike, Mineola, NY 11501 USA.

Objectives: The purpose of this study was to investigate the relationship between operator volume and implantable defibrillator lead failure and patient mortality at a single large implanting center.

Methods: This study analyzed the differences between high-volume and low-volume defibrillator implanters in the Pacemaker and Implantable Defibrillator Lead Survival Study ("PAIDLESS") between February 1, 1996 and December 31, 2011 at NYU Winthrop Hospital. "High-volume" was defined as performing ≥500 implants over the study period, while "low-volume" was defined as performing <500 implants. Read More

Folia Morphol (Warsz) 2016;75(4):543-549. Epub 2016 Nov 10.

Department of Cardiology, Medical University of Warsaw, Poland.

Background: The technique of axillary vein (AV) or subclavian vein (SV) puncture has become an important alternative to cephalic vein (CV) cutdown as an approach allowing cardiac lead introduction into the venous system during cardiac implantable electronic device (CIED) implantation procedures. Irrespective of the technique used, the injury associated with lead insertion may induce a reflex venous spasm that can even cause total venous obstruction. In order to assess the incidence of AV spasm during AV puncture, we analysed a total of 735 (382 in females and 353 in males; mean age 75 ± 11 years) de novo CIED implantation procedures involving transvenous lead insertion conducted between January 2014 and December 2015. Read More

Europace 2017 Jul;19(7):1193-1197

Alice Ho Miu Ling Nethersole Hospital, Hong Kong, People's Republic of China.

Aims: Existing data on the relationship between venous access and long-term pacemaker lead failure (PLF) are scarce and inconsistent. We aim to study the hypothesis that contrast-guided axillary vein puncture (AP) is better than subclavian puncture (SP) and similar to cephalic vein cutdown (CV) in the incidence of PLF and the success rate of AP is higher than CV.

Methods And Results: The case records of 409 patients with 681 implantable pacemaker leads were reviewed. Read More

Cochrane Database Syst Rev 2016 Aug 21(8):CD008942. Epub 2016 Aug 21.

Department of Medical Imaging, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland, Australia, 4102.

Background: Totally implantable venous access ports (TIVAPs) provide patients with a safe and permanent venous access, for instance in the administration of chemotherapy for oncology patients. There are several methods for TIVAP placement, and the optimal evidence-based method is unclear.

Objectives: To compare the efficacy and safety of three commonly used techniques for implanting TIVAPs: the venous cutdown technique, the Seldinger technique, and the modified Seldinger technique. Read More

J Surg Oncol 2016 Jan 8;113(1):114-9. Epub 2015 Dec 8.

Department of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan.

Background: The aims of this retrospective study, were to evaluate totally implantable central venous access device (TICVAD) implantation and to validate the efficacy of preoperative ultrasonography.

Methods: A total of 380 cases implanted with TICVADs were divided into four groups: cut-downs with ultrasonography (group A, n = 112); cut-downs without ultrasonography (group B, n = 37); venous puncture (group C, n = 122); and replacements using the existing catheter (group D, n = 109). Operation time, completion rate, and complications were compared. Read More

Folia Morphol (Warsz) 2015;74(4):458-64

Department of Cardiology, Medical University of Warsaw.

Background: Morphometric parameters of the venous vasculature constitute an important aspect in successful cardiac implantable electronic device (CIED) insertion. The purpose of this study was to present morpho-anatomical variations of the cephalic vein (CV) and their effect on the course of CIED implantation procedures, based on the patients from our centre.

Materials And Methods: We analysed contrast venography results obtained during first-time lead placement. Read More

Medicine (Baltimore) 2015 May;94(17):e728

From the Division of Thoracic and Cardiovascular Surgery (TWS, CFW, PJK, SYY, TCK, HCH, CYW), Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University; and Division of Chest and Critical care (JYF), Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan.

An entry vessel is crucial for intravenous port implantation. A safe alternative entry vessel that can be easily explored is crucial for patients without feasible cephalic vein or for those who need port reimplantation because of disease relapse. In this study, we tried to analyze the safety and feasibility of catheter implantation via the deltoid branch of the thoracoacromial vein. Read More

Heart Rhythm 2015 Aug 23;12(8):1820-6. Epub 2015 Apr 23.

Referral Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia.

Background: Only a few studies on the cephalic vein cutdown technique for pacemaker lead implantation in children weighing ≤10 kg have been reported even though the procedure is widely accepted in adults.

Objective: The purpose of this study was to prove that cephalic vein cutdown for pacemaker lead implantation is a reliable technique with a low incidence of complications in children weighing ≤10 kg.

Methods: The study included 44 children weighing ≤10 kg with an endocardial pacemaker. Read More

Syst Rev 2015 Apr 22;4:53. Epub 2015 Apr 22.

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.

Background: Totally implantable venous access port (TIVAP) implantation is one of the most often performed operations in general surgery (over 100,000/year in Germany). The two main approaches for TIVAP placement are insertion into the cephalic vein through an open cut-down technique (OCD) or closed cannulation technique of the subclavian vein (CC) with Seldinger technique. Both procedures are performed with high success rates and very low complication frequencies. Read More

BMC Surg 2014 May 8;14:27. Epub 2014 May 8.

Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.

Background: The aim of this study was to assess the efficacy and safety of totally implanted vascular devices (TIVAD) using different techniques of insertion.

Methods: We performed a retrospective study using a prospective collected database of 796 consecutive oncological patients in which TIVADs were inserted. We focused on early and late complications following different insertion techniques (surgical cutdown, blind and ultrasound guided percutaneous) according to different techniques. Read More

Can J Surg 2014 Feb;57(1):21-5

The Department of Surgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea.

Background: The jugular vein cutdown for a totally implantable central venous port (TICVP) has 2 disadvantages: 2 separate incisions are needed and the risk for multiple vein occlusions. We sought to evaluate the feasibility of a cephalic vein (CV) cutdown in children.

Methods: We prospectively followed patients who underwent a venous cutdown for implantation of a TICVP between Jan. Read More

Ann Vasc Surg 2014 Feb 17;28(2):345-50. Epub 2013 Dec 17.

Division of Visceral and Transplantation Surgery, University Hospitals of Geneva, Switzerland.

Background: The aim of this study is to determine whether systematic postoperative chest X-ray is required after totally implantable venous access port device (TIVAD) placement under fluoroscopic control.

Methods: A retrospective chart review of all consecutive patients with fluoroscopy-guided TIVAD insertion from July 10, 2009 to April 16, 2012 was conducted at the Geneva University Hospitals (n = 927). Patients with an available postoperative chest X-ray were included, regardless of approach (open or percutaneous) and venous access site (subclavian, cephalic, jugular, etc. Read More

J Cardiovasc Med (Hagerstown) 2017 09;18(9):727-728

Cardiology Unit, Ramazzini Hospital, Via Molinari 1, 41012, Carpi, Modena, Italy.

J Rural Med 2013 30;8(2):233-5. Epub 2013 Nov 30.

Department of Cardiovascular Surgery, Yuri-Kumiai General Hospital, Japan.

Objective: The aim of this report was to discuss validity of pacemaker surgery for elderly individuals over 90 years old.

Patient: We operated on 12 individuals over 90 years old who had syncope or congestive heart failure in association with bradycardia, between January 2005 and November 2012.

Methods: All 12 patients were referred to us by the cardiology department of our hospital for pacemaker surgery. Read More

J Vasc Access 2013 Apr-Jun;14(2):205-6. Epub 2012 Oct 3.

Tunis Med 2011 Aug-Sep;89(8-9):699-702

Service de Chirurgie, Hopital La Rabta, Tunis, Tunisie.

Background: The use of an implantable room has become indispensable in the clinical practice for the cancer patients. The increasing use of these devices was associated with a greater incidence of complications.

Aim: To verify the feasibility of the cephalic vein cut-down technique for placement of venous access devices. Read More

Ann Vasc Surg 2011 Feb 6;25(2):217-21. Epub 2010 Oct 6.

Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan, Republic of China.

Background: We report our experience of using a totally implantable access port (TIAP) through the external jugular vein (EJV) when the cephalic vein (CV) approach is not feasible.

Methods: We reviewed 197 cases involving TIAP implantation through the EJV in a single medical center between January 1995 and January 2009. All the ports were implanted after the CV approach was found unfeasible. Read More

Europace 2010 Sep 2;12(9):1282-5. Epub 2010 Jun 2.

Department of Cardiology, University of Ioannina, Ioannina, Greece.

Aims: We improved the cut-down approach aiming at minimizing the subclavian/axillary vein puncture during implantation of permanent pacemaker leads.

Methods And Results: We incorporated previously reported refinements of the cut-down approach, i.e. Read More

Vascular 2009 Sep-Oct;17(5):273-6

Department of Surgery, Buffalo General Hospital, State University of New York at Buffalo, Buffalo, NY 14203, USA.

For insertion of totally implantable access ports, with the catheter end in the superior vena cava, the percutaneous (Seldinger) technique is commonly used. Of cutdowns, the cephalic vein cutdown is the most popular one (success rate about 80%), followed by the external jugular vein cutdown. Our preliminary experience suggests that internal jugular vein and basilic vein cutdowns have the anatomic features to prove both of them superior to the cephalic vein cutdown. Read More

J Surg Oncol 2008 Sep;98(3):197-9

Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.

Background: The purpose of this study was to develop a modified method to implant a totally implantable access port (TIAP) using the femoral vein approach.

Methods: We designed a modified method using the femoral vein approach to implant a TIAP in patients with synchronous bilateral breast cancer requiring bilateral mastectomy and postoperative chemotherapy. TIAP implantation was performed with parenteral sedation and local anesthesia in the operating room. Read More

Folia Morphol (Warsz) 2008 Feb;67(1):72-7

Department of Anatomical Sciences, St. George's University, School of Medicine, Grenada, West Indies.

Identification and recognition of the cephalic vein in the deltopectoral triangle is of critical importance when considering emergency catheterization procedures. The aim of our study was to conduct a cadaveric study to access data regarding the topography and the distribution patterns of the cephalic vein as it relates to the deltopectoral triangle. One hundred formalin fixed cadavers were examined. Read More

J Clin Anesth 2007 Dec;19(8):609-15

Department of Anesthesiology, Taipei-Veterans General Hospital and National Yang-Ming University, Taipei 112, Taiwan.

Study Objective: To compare percutaneous nonangiographic insertion of a venous access device with a standard surgical cutdown insertion technique.

Design: Prospective, controlled, randomized study.

Setting: Operating room and anesthesia induction room of a university hospital. Read More

Eur J Surg Oncol 2008 Nov 5;34(11):1262-9. Epub 2007 Nov 5.

Department of Radiodiagnostics and Interventional Radiology, Antoine Lacassagne Anticancer Research Institute, Nice Cedex 1, France.

Aim: To compare technical feasibility and complications of radiologically arm port device implantation using arm venography exclusively (API-Group B) with chest port placement using cephalic vein cutdown (CVC-Group A), in advanced consecutive head and neck cancer patients (HNP).

Methods: Port device placement was attempted in 225 consecutive HNP. Decision for inclusion in Group A or B was made first by the availability of the surgeon/radiologist to perform the procedure, second by contraindications of each technique. Read More

Am J Surg 2007 Nov;194(5):699

Int Semin Surg Oncol 2007 Jul 9;4:16. Epub 2007 Jul 9.

Section of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA.

There are several very obvious and simple solutions for eliminating the "Pitfalls" and for minimizing the risk of occurrence of any perioperative complications associated with placement of chronic indwelling central venous access devices in cancer patients. The first is the utilization of a venous cutdown approach, such as the cephalic vein or the external jugular vein, which essentially eliminates potentially life-threatening perioperative complications, such as pneumothorax and injury to the great vessels (with or without associated hemothorax). The second is the selective and appropriate utilization of intraoperative venography for defining the central venous anatomy and for providing a venous roadmap in those particularly challenging cases in which difficulties are encountered during chronic indwelling central venous access device placement. Read More

Pacing Clin Electrophysiol 2007 May;30(5):719-20

Department of Cardiology, St. Bartholomew's Hospital, London, UK.

While the subclavian or axillary vein can be safely and successfully punctured in the majority of cases, some device implanters still prefer cut down to the cephalic vein as the initial approach to venous access for transvenous placement of pacemaker or defibrillator leads out of concern for the risk of pneumothorax, subclavian crush, and other possible complications. However, very occasionally, the cephalic vein crosses superficial to the clavicle to join the external jugular vein, making it rather unappealing for this purpose. Relying on a guide wire introduced through the cephalic vein to guide puncture of the subclavian vein is unlikely to be successful in such a situation and may cause accidental damage to the vital structures in the thoracic inlet region. Read More

J Surg Oncol 2007 Oct;96(5):436-7

Department of Surgery, Yee-Zen General Hospital, Taoyuan, Taiwan.

Background: Totally implantable access ports (TIAP) with cutdown method has few complications, but needs assessment of fluoroscopic system.

Methods: We present a method to confirm the position of TIAP catheter without fluoroscopic assessment. We use the cutdown method and trigger arrhythmia while introducing the TIAP catheter. Read More

J Surg Oncol 2007 Feb;95(2):156-7

Department of Surgery, Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Nei Hu, Taipei, Taiwan, ROC.

Background: Totally implantable access ports (TIAP) placed by the cephalic vein cutdown technique have high failure rates.

Methods: We describe a guidewire assisted technique of the cephalic vein cutdown for TIAP placement that can be easily introduced catheter when difficulties in insertion of the catheter. The key point of the presented technique is the use of J guidewire to go beyond the stenosis and advancement of catheter through the guidewire into the superior vena cava. Read More

Pacing Clin Electrophysiol 2006 Aug;29(8):852-7

Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.

Background: Existing methods of venous access for permanent pacemaker leads have disadvantages. We documented learning times for ultrasound-guided lead implantation and compared them with cephalic venotomy technique.

Methods: Two implanters learnt ultrasound-guided technique by implanting consecutive pacemaker patients. Read More

Am J Surg 2006 Jul;192(1):63-7

Marion Louise Saltzman Women's Center, Albert Einstein Medical Center, 5501 Old York Rd., Philadelphia, PA 19141, USA.

Background: Central venous access devices play an integral role in providing long-term venous access. Percutaneous and cut-down techniques have been used with varying complications.

Methods: Between January 1998 and July of 2001, 358 venous access devices were placed at Albert Einstein Medical Center in Philadelphia, Pennsylvania. Read More

Eur J Surg Oncol 2006 Feb 10;32(1):90-3. Epub 2005 Nov 10.

Division of General Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Sec 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, ROC.

Aim: The aim of the present study was to report our experience of totally implantable central venous access devices (TICVAD) implantation using two techniques and attempt to define the better technique.

Materials And Methods: From January 1998 to September 2003, 1131 patients were reviewed and divided into two groups with implantation by cephalic vein cut-down (group A) done by general surgeons and subclavian vein puncture with the Seldinger technique (group B) done by vascular surgeons. The operative time, early and late complications of these two groups were compared. Read More

Heart Rhythm 2005 Jul;2(7):714-9

Division of Cardiology, University Jean Monnet of Saint-Etienne, 42055 Saint-Etienne, France.

Background: Biventricular pacing is useful for patients with congestive heart failure but has the disadvantage of being a long, user-dependent, highly technical procedure.

Objectives: The purpose of this study was to simplify the procedure. The simplified technique consists of sinus (CS) venography prior to implantation, direct coronary access for the left ventricular (LV) lead without use of a left-heart delivery system, and triple-guide/one introducer cephalic vein access as the first approach in patients presenting in sinus rhythm. Read More

Breast Cancer Res Treat 2005 Jul;92(1):61-7

Radiology Department, Centre Antoine Lacassagne, Nice, France.

Purpose: The present study is designed to evaluate and compare percutaneous radiologic arm port (R) and surgical subclavian port (S) devices in two homogeneous sets of breast cancer patients in terms of safety, efficacy, quality of life (QoL) and cost analysis.

Material And Methods: This study involved a retrospective review of a prospective databank including 200 consecutive port device implantation attempted procedures performed over a 4-year period, in two similar groups of 100 breast cancer women who underwent either the surgical cephalic vein cutdown approach or the percutaneous basilic vein catheterization for intravenous adjuvant chemotherapy. Parameters analyzed included technical success, procedure duration, complications, QoL and cost evaluation for both techniques. Read More

Ann Surg Oncol 2005 Jul 5;12(7):570-3. Epub 2005 May 5.

Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina, 829, 95126 Catania, Italy.

Background: Cephalic vein (CV) cut down for totally implantable venous access device (TIVAD) placement has been accepted as an alternative to the percutaneous subclavian vein approach. The aim of this retrospective study was to validate the external jugular vein (EJV) cut-down approach when the CV is not feasible.

Methods: Patients receiving a TIVAD from January 1995 to December 2003 were included in this study. Read More

Pacing Clin Electrophysiol 2005 Apr;28(4):324-5

Department of Cardiology, Faculty of Medicine, University of Nice Sophia Antipolis, France.

When the cephalic vein route is not easily accessible for the introduction of permanent stimulation/defibrillation leads, retro-pectoral veins can be looked for, which are usually present and suitable in most patients. As with the cephalic vein route, it is a safer approach than direct subclavian vein puncture. Moreover, using a guidewire and a split introducer increases the rate of successful cannulation. Read More

Chir Ital 2004 May-Jun;56(3):437-42

Department of Medical and Surgical Sciences, 3rd General Surgery Clinic, Coloproctology Units, S. Antonio Hospital, University of Padua.

The use of totally implantable prolonged venous access devices (TIPVAD) in chemotherapy for oncological patients is now consolidated practice, whereas the choice between surgical cutdown and the percutaneous technique is still a controversial matter. The aim of this study was to retrospectively evaluate the validity and safety of the surgical approach by comparison with percutaneous techniques. Over a period of 17 months, 106 patients (mainly oncological cases) underwent surgical cutdown for TIPVAD placement in the cephalic vein. Read More

World J Surg Oncol 2004 Apr 16;2. Epub 2004 Apr 16.

Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute, The Ohio State University, Columbus, Ohio 43210-1228, USA.

Background: Cephalic vein (CV) cutdown approach for chronic indwelling central venous access device (CICVAD) placement has previously been shown to be technically feasible in 82% of cancer patients. No data are available as to the potential utilization of external jugular vein (EJV) cutdown approach in cancer patients when CV cutdown approach is not technically feasible.

Patients And Methods: One hundred and twenty consecutive cancer patients were taken to the operating room with the intention of placing a CICVAD. Read More

Pacing Clin Electrophysiol 2003 Dec;26(12):2313-4

Division of Cardiology, G.B. Grassi Hospital, Rome, Italy.

The cephalic vein (CV) should be preferred to the subclavian vein for the insertion of permanent pacing leads because of better results. Unfortunately, the direct lead introduction using the standard CV cutdown is often unsuccessful. This study evaluated the efficacy and safety of a steerable hydrophilic guidewire (HGW) for lead insertion through the CV. Read More

Int J Cardiol 2003 11;92(1):55-8

Cardiology Team, Department of Medicine & Geriatrics, Princess Margaret Hospital, Princess Margaret Hospital Road, Kowloon, Hong Kong, Hong Kong.

Background And Objectives: Biventricular pacing is a new modality of treatment for patients with drug-refractory heart failure and ECG evidence of dyssynchronous ventricular contraction. A third lead is required to be placed in a coronary vein through the coronary sinus for left ventricular pacing, in addition to the atrial and right ventricular leads. Subclavian crush phenomenon is associated with lead placement using subclavian puncture. Read More

Chir Ital 2003 Mar-Apr;55(2):313

Chir Ital 2003 Jan-Feb;55(1):149-50

Chir Ital 2002 Jul-Aug;54(4):495-500

Dipartimento di Chirurgia P. Valdoni II Facoltà di Medicina e Chirurgia Università degli Studi di Roma La Sapienza.

The aim of the present study was to evaluate the results of a prospective randomised trial comparing cephalic vein cut-down (CCD) versus percutaneous subclavian vein puncture with the Seldinger technique (PSP) in the implantation of subcutaneous permanent central venous access devices (SPCVAD) in order to better define the safer technique in outpatient surgery. Fifty patients were randomly divided into two groups: CCD--17 males, 8 females (age range: 35-75 years; mean: 60 years); PSP--17 males, 8 females (age range: 17-75 years; mean: 63 years). The two groups were compared in terms of implant morbidity, technical failure, operative time, patient acceptance, and healthcare costs. Read More

Acta Chir Belg 2002 Jun;102(3):214-5

First Surgical Clinic, University of Catania, Catania, Italy.

Since the first report of TIVD implantation, many authors have published immediate and post-operative complications. The Authors report the first case in which the catheter, implanted via the cephalic vein by cutdown technique, has migrated completely out of the vein. In order to avoid extravascular migration, during the surgical procedure, the catheter should be fixed at the vein with nonabsorbable sutures, taking care to avoid narrowing the catheter lumen. Read More

Arch Surg 2002 Jun;137(6):746-7

Am J Cardiol 2000 Mar;85(6):774-6, A9

Northern California Cardiology Associates, Sacramento, USA.

Complication rates after pacemaker implantation decline after increasing operator experiences (total cases), activity (cases per year), and facility with cephalic vein cutdown technique. The incremental cost of care is driven by hospital resource utilization and does not parallel medical severity. Read More