Axillary subpectoral approach for pacemaker or defibrillator implantation in patients with ipsilateral prepectoral infection and limited venous access.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
Mohammad Al-BatainehS Kutalek

Abstract

The prepectoral approach is the procedure of choice for pacemaker or defibrillator (device) implantation. Epicardial or transiliac approaches are reserved for patients in whom the pectoral approach is not feasible. We studied the viability of the axillary subpectoral approach for implanting devices in patients in whom the standard prepectoral approach was not feasible. Devices and leads were extracted from 16 patients with infected devices in the prepectoral position. The contralateral site was unsuitable for reimplantation because of infection or inadequate venous access. On the side ipsilateral to that with prior prepectoral device infection, we made an incision on the anterior axillary line along the border of the pectoralis major; dissection was continued below the muscle to create a pocket for generator implantation. Axillary venous puncture was performed from the axillary incision and beneath the pectoralis major muscle using a long 14-gauge needle. Long guidewires and peel-away sheaths were used for positioning the lead. The generator was placed in the subpectoral pocket; the wound was closed with absorbable sutures. One patient developed a pocket hematoma; one developed a pneumothorax; no other surgical complication, le...Continue Reading

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Citations

Sep 18, 2014·Pacing and Clinical Electrophysiology : PACE·Mahito NoroKaoru Sugi
May 22, 2018·Annals of Plastic Surgery·Andrew M SimpsonW Bradford Rockwell
Dec 28, 2018·The Laryngoscope·Nicholas L DeepStephen F Bansberg
Sep 24, 2021·Pacing and Clinical Electrophysiology : PACE·Yoshinari EnomotoMasato Nakamura

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