Background: Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the
most commonly used access sites for transvenous lead placement of cardiac implantable
electronic devices (CIEDs). Limited knowledge exists about the long-term patency of
the vascular lumen housing the leads. Methods: Among the 2703 patients who underwent
CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients
scheduled for an elective CIED replacement (median of 6.4 years after the first operation).
The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1-69%,
Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized stenosis
categorization exists, experienced physicians in consensus with the involved team
made the applied distribution. The primary endpoint was the occurrence of stenosis
Type III or IV in the CVC group and in the SVP group. Results: In total, 162 patients
with venography were enrolled in this study. The prevalence of high-degree stenosis
was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73,
20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%)
than in the SVP group (median 42%). Conclusions: The present study showed that the
long-term patency of the subclavian vein is higher after CVC than after SVP for venous
access in patients with CIED.
