Ultrasound‐guided venipuncture for implantation of cardiac implantable electronic devices: A single‐center, retrospective study

Abstract

BackgroundThe venous access for the insertion of permanent leads of cardiac implantable electronic devices is often achieved by venous cutdown of the cephalic vein, or by “blind” puncture of the subclavian vein using anatomical landmarks, or by fluoroscopy‐assisted methods.MethodsWe have retrospectively analyzed our clinical experience to verify the feasibility, the safety, and efficacy of the adoption of ultrasound‐guided puncture/cannulation of the axillary vein for this purpose.ResultsNine hundred eighty‐seven leads were placed during 548 consecutive procedures, accessing the axillary vein in the infraclavicular area using real‐time ultrasound guidance. Venipuncture was successful in 99.8% of cases. The access time was 11 seconds (range 4‐580). We recorded three cases of pneumothorax (0.5%), but no hemothorax and no hemo‐mediastinum. The incidence of local hematoma was 2.1% (12 cases). No injury to the brachial plexus or to the phrenic nerve was recorded. In a follow‐up of 33 months (range 16‐39), we observed no cases of “subclavian crush syndrome” (damage of the leads at the level of the thoracic inlet), and the rate of pocket infection/infective endocarditis was 0.7%.ConclusionIn our experience, ultrasound‐guided puncture/cannulation of the axillary vein for implantation of permanent leads is feasible, effective, and safe. It might be considered as a first option for this procedure.

UltraSound Axillary Vein Access (USAA): Learning curve and randomized comparison to traditional venous access for cardiac device implantation

“…We report a 94% success rate for USAA, similar to the 88%−100% reported success rate in previous studies despite the inclusion of operators without experience in the technique 3,5,7–10,12–18 . In our study, when USAA was unsuccessful, operators switched to an alternative non‐US technique.…”

“…We We report a 94% success rate for USAA, similar to the 88%−100% reported success rate in previous studies despite the inclusion of operators without experience in the technique. 3,5,[7][8][9][10][12][13][14][15][16][17][18] In our study, when USAA was unsuccessful, operators switched to an alternative non-US technique. Alternatively, USAA could have been considered after the formation of the device pocket, which would result in less distance to the axillary vein but, depending on the available probe, might require a larger incision.…”

“…3,9,13,17 These factors, variable methods for collecting times, and the inclusion of inexperienced US operators in our study may explain longer VA times than reported in some other studies. 3,5,8,9,13,[16][17][18] The longer pocket formation time in this study may be explained by differences in the techniques as the pocket was created prior to access in the conventional group (without wires in the way). With USAA, access was obtained initially and the pocket was made with the wires in the area, which may have increased the time for pocket formation.…”

Cephalic vein access by modified Seldinger technique for lead implantations

“…Axillary vein puncture may be a very valuable alternative to both cephalic venous cut down and subclavian vein puncture. Vascular access can be achieved with use of fluoroscopic anatomical landmarks only, 6,17 or guided by intravenous contrast 18 or ultrasound 19 for visualization of the venous anatomy. To further reduce the risk of pneumothorax, Yang et al 20 utilized a fluoroscopic approach with caudal angulation to facilitate axillary venous access.…”

“…To further reduce the risk of pneumothorax, Yang et al 20 utilized a fluoroscopic approach with caudal angulation to facilitate axillary venous access. In the recent years, there is a growing interest in this technique, reflected by several reports showing promising success rates 6,9,10,19,21 and low complication rates 9,10 . However, up to date only three studies prospectively randomized patients between axillary vein puncture and cephalic cut down 6,9,10 .…”