Caudal-Tilt Ultrasound Guided Axillary Venous Access for Transvenous Pacing Lead Implant

A limitation of ultrasound (US) guided venous access (VA) for transvenous pacing lead implant is that extrathoracic venous access often results in relatively lateral venous entry, resulting in patient discomfort, and more acute bends as the lead traverses from the pocket to the heart. Caudal-tilt fluoroscopy is an established technique for visualization of the space between the anterior border of the first rib and the clavicle, which facilitates more medial axillary VA with reduced pneumothorax risk.