ペーシング・リード挿入に鎖骨下静脈穿刺標準法は避けるべきか—リード・ストレスの検討

Should the Standard Subclavian Approach for Endocardial Pacing Lead Implantation be Avoided?

　上肢下垂および挙上による肋鎖部でのリード・ストレスを胸部X線写真により鎖骨下静脈穿刺標準法（標準法）52例，胸郭外鎖骨下静脈穿刺法（胸郭外法）61例，腋窩静脈穿刺法（腋窩法）3例で検討した．ストレスの頻度は，標準法では圧迫が11.5％，牽引が84.6％と非常に多い．一方，胸郭外法と腋窩法では圧迫はなく，牽引は3.1％と極めて少ない．また，胸郭外法と腋窩法の手術に伴う合併症は，静脈攣縮1例（0.95％）と極めて少なかった．以上より，穿刺によるリード挿入法として，標準法を極力避け胸郭外法か腋窩法を行うべきである．

We reviewed our experience in 116 patients whounderwent implantation of endocardial pacing leads, todetermine the incidence of stress imposed by the sub-clavian soft tissues (costoclavicular ligament and sub-clavius muscle) as they respond to movements of theupper extremity. Chest X rays have shown two types ofstress, compression with depression of the clavicle andtraction with elevation of the clavicle. In 52 patients ofstandard subclavian venipuncture, compression has oc-cured in 6 patients (11.5 %) and traction in 44 patients(86.4%). In 61 patients of extrathoracic subclavianvenipuncture and 3 patients of axillary venipuncture, nocompression has occured in 64 patients and traction hasoccurred in 2 patients (3.1%). In 97 patients of extra-thoracic subclavian venipuncture and 8 patients of axil-lary venipuncture, there has been only one venoconstric-tion for an overall complication rate of 0.95%.

In summary, our data suggests that endocardial pac-ing leads should be placed by using the extrathoracicapproach and probably not be placed by the standardapproach.