Ultrasound-Guided Venous Axillary Access Versus Standard Fluoroscopic Technique for Cardiac Lead Implantation

• DOI: 10.1016/j.jacep.2023.11.020
• Publication Date: 2024-01-17T22:01:27Z
• Authors: Francesco Vitali; Michele Malagù; Nicola Bianchi; Martina De Raffele; Marco Manfrini; Federico Gibiino; Alberto Boccadoro; Giorgia Azzolini; Cristina Balla; Matteo Bertini
• Keywords: Axillary vein; Subclavian vein; Cephalic vein; Hemothorax; Axillary artery

Axillary vein puncture (AVP) and cephalic surgical cutdown are recommended in international guidelines because of their low risk pneumothorax chronic lead complications. Directly visualizing puncturing the axillary under ultrasound guidance reduces radiation exposure, provides direct needle visualization, lowers periprocedural Our hypothesis is that ultrasound-guided access safer more feasible than standard fluoroscopic technique. The purpose this study was to assess efficacy safety venous during cardiac implantation for pacemakers (PMs) implantable cardioverter-defibrillator (ICD) implantations. Patients were randomized a 1:1 fashion either or access. composite outcome, including pneumothorax, hemothorax, inadvertent arterial puncture, pocket hematoma, infection, dislodgement, death, evaluated 30 days after implantation. We 270 patients into 2 groups: group fluoroguided AVP (n = 134) experimental 136). No disparities baseline characteristics observed between groups. median age 81 years, with women comprising 41% population. majority received single- dual-chamber PMs (87% vs 88%; P 1.00), slightly over 10% both groups ICDs (13% 12%; 0.85). In total, we placed 357 leads 48 ICDs. Among these, 295 inserted via 110 Notably, subclavian never used as vascular outcome lower according intention-to-treat analysis (OR: 0.55; 95% CI: 0.31-0.99; 0.034). main difference within incidence (17% 6%; 0.004). also exhibited total procedural x-ray exposure (10,344 μGy × cm2 7,119 cm2; 0.002) while achieving same rate success at first attempt (61% 69%; 0.375). Ultrasound-guided fluoroscopy-guided approach it achieves acute maintaining exposure. Ultrasound should be considered optimal method (Ultrasound Guided Access Standard Fluoroscopic Technique Cardiac Lead Implantation [ZEROFLUOROAXI]; NCT05101720)