There is some evidence of lead crush with subclavian access, but there is little evidence of lead erosion via axillary and cephalic routes. Is that really correct?
The question has been asked many times and in different forms.
The approach using a cutdown to introduce the lead directly or with guidewires and dilators into a vein that is somewhat small is superior to subclavian or axillary venipuncture not only in terms of safety for the patient (no pneumothorax, no hemothorax), but also in terms of lead longevity.
See this report by Dr. Parsonnet and Roelke. Interestingly, Dr. Parsonnet was one of the first authors who reported on the use of peel-away introducers.
Pacing and Clinical Electrophysiology
Volume 22, Issue 5, Article first published online: 30 JUN 2006
Dr Furman and Gross and their co workers described a similar problem with defibrillator leads in
Lead fracture in cephalic versus subclavian approach with transvenous implantable cardioverter defibrillator systems.
Gallik DM1, Ben-Zur UM, Gross JN, Furman S.
Pacing Clin Electrophysiol. 1996 Jul;19(7):1089-94
I hope this helps. The references are by no means exhaustive but from very well respected sources, two of the founders of the Hearth Rhythm society, then called "NASPE".
It really pays in the long run to learn to do cephalic cutdown and to use it as your preferred approach.
Thank you,
Jorge Camuñas
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