Site of left axillary vein crossing the clavicle: an analysis with computed tomography venography as a guide for vein puncture for device implantation.

BACKGROUND

Blind axillary venous access is a convenient but technically difficult approach for cardiac rhythm device lead implantation. We try to explore whether there are rules on the axillary vein course to facilitate blind venous cannulation.

METHODS

In a single-center, retrospective study, we included 155 patients who underwent computed tomography venography (CTV) examination of left axillary vein. All scans were reviewed for the relationship between left axillary vein and clavicle, vein steepness, and depth. Factors probably affecting above indicators were analyzed.

RESULTS

The location of left axillary vein crossing the clavicle was mainly concentrated around the medial 1/3 of clavicle, with mean crossing location of the medial 1/3 of clavicle, which was not correlated with sex, age, abdominal subcutaneous fat thickness, upper thoracic kyphosis angle, or the angle between clavicle and anterior midline (P < 0.05). The average angle between axillary vein and horizontal line was 31.57 ± 11.72°, which was positively associated with age, whereas inversely associated with the angle between clavicle and anterior midline (P < 0.05). The proximal axillary vein ran more and more shallow until becoming the subclavian vein (P < 0.01); and it had a mean depth of 3 cm, which was significantly associated with abdominal subcutaneous fat thickness (P < 0.05).

CONCLUSIONS

The left axillary vein and clavicle had a relatively fixed relationship that axillary vein commonly crossed the medial 1/3 of clavicle. The average angle between axillary vein and horizontal line was 31.57 ± 11.72°, associated with age and the clavicle course. The mean depth of proximal axillary vein was 3 cm, and patients with larger weight had a deeper position of axillary vein.