Success and Complication Rate of Fluoroscopic, Doppler, and Contrast Venography-Guided Subclavian Venous Puncture for Implantation of Cardiovascular Electronic Devices

Background: Cardiovascular implantable electronic devices (CIED) are life-saving devices, but may lead to puncture-related complications during implantation. Aim: The aim of this study was to compare the success and complications of the subclavian venous puncture under the guidance of fluoroscopy, venography, and Doppler. Methods: This was a prospective observational study conducted for one year at a tertiary health center in North India. We studied the clinical profile, success, and complications in three puncture techniques for CIED lead implantation in 75 adult patients of >18 years of age, randomized in three equal groups of 25 participants. Results: The mean age was 66.6 ± 15.6 years, with the majority being males. The left-sided approach for lead implantation was common (84%). Pacemakers were most commonly implanted CIED devices. The overall success of punctures was 100% each in Doppler and venography group, and 92% in the fluoroscopic-guided venous puncture group. Success in the first attempt was observed in 48% in the Doppler group and 24% each in the fluoroscopic and venographic group. There were total of 12 complications, the most common were arterial puncture (10.7%), followed by major hematoma (4%), and pneumothorax (1.3%). The fluoroscopic group had maximum complications (83%), followed by the venography group. Significantly higher arterial punctures occurred in the fluoroscopic venous puncture group. Conclusion: There were 100% success in the Doppler and venographic groups and only 92% success in the fluoroscopic venous puncture group. Maximum complications were seen in the fluoroscopic group, with significantly higher arterial punctures seen in the fluoroscopic venous puncture group.