A randomized study about safety and efficacy of ultrasound-guided axillary versus subclavian venous approaches for device leads implantation

Congress:

ECR 2019

Poster Number:

C-2336

Type:

Scientific Exhibit

Keywords:

Haemodynamics / Flow dynamics, Cardiac Assist Devices, Venous access, Puncture, Catheters, Ultrasound, Percutaneous, Conventional radiography, Vascular, Interventional vascular, Cardiac

Authors:

M. Liccardo¹, S. Capuano², P. Nocerino¹, C. Ciardiello³, A. coletta³, L. D'Alessandro⁴, A. G. P. Ciniglio⁵, R. Lobianco⁶; ¹pozzuoli/IT, ²Lacco Ameno/IT, ³Napoli/IT, ⁴ancona/IT, ⁵Ottaviano (NA)/IT, ⁶Napoli (NA)/IT

DOI:

10.26044/ecr2019/C-2336

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2336

Fig. 1: Flow chart of study population

Fig. 2: Study population parameter

Fig. 3: Periprocedural complications

Fig. 4: Follow up (24 months) complications

Aims and objectives

Venous access is the first step in lead insertion for pacemaker or implantable cardioverter defibrillator (ICD) [1-2]. It can be performed by different methods: subclavian vein puncture and cephalic vein cut-down techniques are the most common [3-5]. Axillary vein puncture has been proposed as an alternative approach for lead implantation, although axillary vein puncture is safe, simple and more effective technique than standard intrathoracic approaches, randomized study and conclusive data are still lacking. The aim of this study was to compare the efficacy of the...

Methods and materials

This randomized comparative study was performed on 174 patients: as a first attempt, 116 patients underwent the ultrasound-guided axillary access and 58 patients underwent the subclavian approach. A total of 364 leads were placed. Operators were trained in ultrasound-guided vein access technique.

Results

Axillary access was successful in 69% of patients (32/46), in the training phase and, as a first attempt, in 91.4% of patients (106/116), in the randomized phase. When axillary approach failed, we performed: subclavian access in 5.2% of patients (6/116); cephalic approach in 2.6% of patients (3/116); surgical method in 0.9% of patients (1/116). The subclavian technique was effective, as a first attempt, in 55 patients (94.8%). When the subclavian access failed, the ultrasound axillary approach successfully performed in all the 3 cases. During a...

Conclusion

As first attempt, ultrasound-guided axillary method showed similarly high success rate than subclavian approach, and well performed when the first attempt in subclavian group failed. Axillary access can be considered a safe and effective alternative technique to the conventional subclavian method for device implantation

Personal information

References

1.Dana A.V. Braner, M.D., Susanna Lai, M.P.H., Scott Eman, B.S., and Ken Tegtmeyer, M.D. Central Venous Catheterization — Subclavian Vein. N Engl J Med 2007; 357:e26 2.Orihashi K, Imai K, Sato K, Hamamoto M, Okada K, Sueda T. Extrathoracic subclavian venipuncture under ultrasound guidance. Circ J 2005;69:1111-5 3.Pirotte T, Veyckemans F. Ultrasoundguided subclavian vein cannulation in infants and children: a novel approach. Br J Anaesth 2007;98:509-14. 4.Aggarwal RK, Connelly DT, Ray SG, et al. Early complications of permanent pacemaker implantation: No difference between dual and...