Int J Arrhythm.  2021 Dec;22(4):19. 10.1186/s42444-021-00049-5.

Sex‑related differences regarding cephalic vein lead access for CIEDs implantation

  • 1Department of Cardiac Electrophysiology and Electrostimulation, University Clinic of Cardiology, Bul. Mother Teresa 17, 1000 Skopje, Republic of North Macedonia.
  • 2University Clinic of Hematology, 1000 Skopje, Republic of North Macedonia.


Minimally invasive and safe central venous access is imperative for lead insertion of cardiac implantable electronic devices (CIEDs). The purpose of this trial was to explore and compare the usability of the cephalic vein (CV) between both sexes.
Methods and results
This single-center prospective study included 102 consecutive patients in a period of six months. Pre-procedural contrast-enhanced venographic images of the upper arm were performed in all included patients. Our attention was focused on comparing several morpho-anatomical CV characteristics such as venous diameter, presence of valves and angle of entrance of the CV into the subclavian vein (SV). Study results concerning the CV morpho-anatomical differences were more favorable regarding the female patient group, with significant differences in CV diameter (p-0.030). There was also a difference in favor of the female group regarding the favorable CV angle of entrance into the SV, found in the 61.7% versus 54.4% in the male patient group. The comparison of usability of the CV and CVC technique was explored by comparing the number of leads inserted through the CV in both sexes. Two leads were implanted in 11.7% in the female group versus 5.8% in the male group, and 0 leads through the CV in 38.2% of the female patients versus 50% of male group.
Female patients have more favorable cephalic vein morpho-anatomical futures and better usability for lead placement than male patients.


Sex differences; Cephalic vein; Axillary vein; Subclavian vein; Device implantation
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