Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation

Abstract

Introduction Ultrasound guided axillary vein access (UGAVA) is an emerging approach for cardiac implantable electronic device (CIED) implantation not widely utilized. Methods and Results This is a retrospective, age and sex‐matched cohort study of CIED implantation from January 2017 to July 2019 comparing UGAVA before incision to venous access obtained after incision without ultrasound (conventional). The study population included 561 patients (187 with attempted UGAVA, 68 ± 13 years old, 43% women, body mass index (BMI) 30 ± 8 kg/m2, 15% right‐sided, 43% implantable cardioverter‐defibrillator, 15% upgrades). UGAVA was successful in 178/187 patients (95%). In nine patients where UGAVA was abandoned, the vein was too deep for access before incision. BMI was higher in abandoned patients than successful UGAVA (38 ± 6 vs. 28 ± 6 kg/m2, p < .0001). Median time from local anesthetic to completion of UGAVA was 7 min (interquartile range [IQR]: 4–10) and median procedure time 61 min (IQR: 50–92). UGAVA changed implant laterality in two patients (avoiding an extra incision in both) and could have prevented unnecessary incision in four conventional patients. Excluding device upgrades, there was reduced fluoroscopy time in UGAVA versus conventional (4 vs. 6 min; IQR: 2–5 vs. 4–9; p < .001). Thirty‐day complications were similar in UGAVA versus conventional (n = 7 vs. 26, 4 vs. 7%; p = .13, p = .41 adjusting for upgrades), partly driven by a trend towards reduced pneumothorax (n = 0 vs. 3, 0 vs. 1%; p = .22). Conclusions UGAVA is a safe approach for CIED implantation and helps prevent an extra incision if a barrier is identified changing laterality preincision.

The Use of a Handheld Ultrasound Device to Guide the Axillary Vein Access during Pacemaker and Cardioverter-Defibrillator Implantation. A Feasibility Study

“…[9,10,[14][15][16][17][18][19]), our results paralleled the most recent literature on ultrasound-guided AV access for the same procedure type. Indeed, although the studies were somewhat different in ultrasound-guided venipuncture techniques and ultrasound system machines (i.e., on-cart, portable, or wireless), the success rate proved similar across the patient groups with USGAVA, including our procedures performed by a handheld device [9,10,[14][15][16][17][18][19]. Conversely, the complication rate was quite different between studies, probably affected either by the different follow-up duration or the broad definition of procedurerelated complications, as some of these were unlikely related to the venous cannulation technique.…”

“…As shown in Table 3 (Ref. [9,10,[14][15][16][17][18][19]), our results paralleled the most recent literature on ultrasound-guided AV access for the same procedure type. Indeed, although the studies were somewhat different in ultrasound-guided venipuncture techniques and ultrasound system machines (i.e., on-cart, portable, or wireless), the success rate proved similar across the patient groups with USGAVA, including our procedures performed by a handheld device [9,10,[14][15][16][17][18][19].…”

“…Our data Esmaiel [14] Franco [15] Lin [16] Liccardo [10] Tagliari [9] Eljamili [17] De Sensi [18] Chandler [19] Study under antithrombotic therapy undergoing CIED implantation with USGAVA, including cardioverter-defibrillators and CRT [17].…”

A Practical Guide to Ultrasound-guided Venous Access During Implantation of Pacemakers and Defibrillators

“… 13 Chandler et al reported that, in a cohort study of 561 patients, US-guided axillary vein access before incision was safe and could help prevent an extra incision if a barrier is identified that necessitates a change in laterality. 14 …”

A Sound Method for Axillary Vein Access

“…These approaches remain popular, perhaps due to operators' reluctance to adopt a new technique in the absence of a randomized trial to support a substantial benefit. Chandler et al [7] present their retrospective experience of US-guided access for transvenous device implantation from a single center. This study's results are significant, showing a 95% success rate with US guidance regardless of laterality.…”