Optimized Axillary Vein Technique versus Subclavian Vein Technique in Cardiovascular Implantable Electronic Device Implantation: A Randomized Controlled Study
Peng Liu, Yi-Feng Zhou, Peng Yang, Yan-Sha Gao, Gui-Ru Zhao, Shi-Yan Ren, Xian-Lun Li, Peng Liu, Yi-Feng Zhou, Peng Yang, Yan-Sha Gao, Gui-Ru Zhao, Shi-Yan Ren, Xian-Lun Li
Abstract
Background: The conventional venous access for cardiovascular implantable electronic device (CIED) is the subclavian vein, which is often accompanied by high complication rate. The aim of this study was to assess the efficacy and safety of optimized axillary vein technique.
Methods: A total of 247 patients undergoing CIED implantation were included and assigned to the axillary vein group or the subclavian vein group randomly. Success rate of puncture and complications in the perioperative period and follow-ups were recorded.
Results: The overall success rate (95.7% vs. 96.0%) and one-time success rate (68.4% vs. 66.1%) of punctures were similar between the two groups. In the subclavian vein group, pneumothorax occurred in three patients. The subclavian gaps of three patients were too tight to allow operation of the electrode lead. In contrast, there were no puncture-associated complications in the axillary vein group. In the patient follow-ups, two patients in the subclavian vein group had subclavian crush syndrome and both of them received lead replacement. The incidence of complications during the perioperative period and follow-ups of the axillary vein group and the subclavian vein group was 1.6% (2/125) and 8.2% (10/122), respectively (χ2 = 5.813, P = 0.016).
Conclusion: Optimized axillary vein technique may be superior to the conventional subclavian vein technique for CIED lead placement.
Trial registration: www.clinicaltrials.gov, NCT02358551; https://ichgcp.net/clinical-trials-registry/NCT02358551?term=NCT02358551& rank=1.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5126153/bin/CMJ-129-2647-g001.jpg)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5126153/bin/CMJ-129-2647-g002.jpg)
References
- Tobin K, Stewart J, Westveer D, Frumin H. Acute complications of permanent pacemaker implantation: Their financial implication and relation to volume and operator experience. Am J Cardiol. 2000;85:774–6. A9. doi: 10.1016/S0002-9149(99)00861-9.
- Magney JE, Flynn DM, Parsons JA, Staplin DH, Chin-Purcell MV, Milstein S, et al. Anatomical mechanisms explaining damage to pacemaker leads, defibrillator leads, and failure of central venous catheters adjacent to the sternoclavicular joint. Pacing Clin Electrophysiol. 1993;16(3 Pt 1):445–57. doi: 10.1111/1540-8159.1993.tb01607.x.
- Belott P. How to access the axillary vein. Heart Rhythm. 2006;3:366–9. doi: 10.1016/j.hrthm.2005.10.031.
- Luo GH, Li WJ, Zhong SZ, Li ZH, Fang J. Modification of the right subclavian vein catheterization and its anatomic basis and techniques. Chin Med J. 2005;118:645–53.
- Aizawa Y, Negishi M, Kashimura S, Nakajima K, Kunitomi A, Katsumata Y, et al. Predictive factors of lead failure in patients implanted with cardiac devices. Int J Cardiol. 2015;199:277–81. doi: 10.1016/j.ijcard.2015.07.055.
- Nocito A, Wildi S, Rufibach K, Clavien PA, Weber M. Randomized clinical trial comparing venous cutdown with the Seldinger technique for placement of implantable venous access ports. Br J Surg. 2009;96:1129–34. doi: 10.1002/bjs.6730.
- Knight BP, Curlett K, Oral H, Pelosi F, Morady F, Strickberger SA. Clinical predictors of successful cephalic vein access for implantation of endocardial leads. J Interv Card Electrophysiol. 2002;7:177–80. doi: 10.1023/A: 1020893923079.
- Calkins H, Ramza BM, Brinker J, Atiga W, Donahue K, Nsah E, et al. Prospective randomized comparison of the safety and effectiveness of placement of endocardial pacemaker and defibrillator leads using the extrathoracic subclavian vein guided by contrast venography versus the cephalic approach. Pacing Clin Electrophysiol. 2001;24(4 Pt 1):456–64. doi: 10.1046/j.1460-9592.2001.00456.x.
- Starck CT, Caliskan E, Klein H, Steffel J, Schoenrath F, Falk V. Results of transvenous lead extraction of coronary sinus leads in patients with cardiac 4,703 resynchronization therapy. Chin Med J. 2013;126:4703–6. doi: 10.3760/cma.j.issn.0366-6999.20131925.
- Hua W, Ding LG, Fan XH, Liu ZM, Jiang CL, Qu FJ, et al. Initial Experience with MultiPoint Pacing Cardiac Resynchronization Therapy in China. Chin Med J. 2016;129:1241–3. doi: 10.4103/0366-6999.181966.
- Roger C, Sadek M, Bastide S, Jeannes P, Muller L, Bobbia X, et al. Comparison of the visualisation of the subclavian and axillary veins: An ultrasound study in healthy volunteers. Anaesth Crit Care Pain Med. 2016 pii: S2352-556830091-1. doi: 1016/j.accpm.2016.05.007.
- Nickalls RW. A new percutaneous infraclavicular approach to the axillary vein. Anaesthesia. 1987;42:151–4. doi: 10.1111/1365-2044.1987.tb02988.x.
- Higano ST, Hayes DL, Spittell PC. Facilitation of the subclavian-introducer technique with contrast venography. Pacing Clin Electrophysiol. 1990;13:681–4. doi: 10.1111/j.1540-8159.1990.tb02086.x.
- Burri H, Sunthorn H, Dorsaz PA, Shah D. Prospective study of axillary vein puncture with or without contrast venography for pacemaker and defibrillator lead implantation. Pacing Clin Electrophysiol. 2005;28(Suppl 1):S2801–3. doi: 10.1111/j.1540-8159.2005.00039.x.
- Sharma G, Senguttuvan NB, Thachil A, Leong D, Naik N, Yadav R, et al. A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion. Can J Cardiol. 2012;28:542–6. doi: 10.1016/j.cjca.2012.02.019.
- Antonelli D, Feldman A, Freedberg NA, Turgeman Y. Axillary vein puncture without contrast venography for pacemaker and defibrillator leads implantation. Pacing Clin Electrophysiol. 2013;36:1107–10. doi: 10.1111/pace.12181.
- Silvetti MS, Placidi S, Palmieri R, Righi D, Ravà L, Drago F. Percutaneous axillary vein approach in pediatric pacing: Comparison with subclavian vein approach. Pacing Clin Electrophysiol. 2013;36:1550–7. doi: 10.1111/pace.12181.
- Franco E, Rodriguez Muñoz D, Matía R, Hernandez-Madrid A, Carbonell San Román A, Sánchez I, et al. Wireless ultrasound-guided axillary vein cannulation for the implantation of cardiovascular implantable electric devices. J Cardiovasc Electrophysiol. 2016;27:482–7. doi: 10.1111/jce.12917.
- Imnadze G, Awad K, Wolff E, Amberger J, Franz N, Thale J, et al. Anovel method of axillary venipuncture using the cephalic vein as a sole anatomic landmark. Can J Cardiol. 2015;31:1067–9. doi: 10.1016/j.cjca.2015.02.021.
- Al Fagih A, Ahmed A, Al Hebaishi Y, El Tayeb A, Dagriri K, Al Ghamdi S. An initiative technique to facilitate axillary vein puncture during CRT implantation. J Invasive Cardiol. 2015;27:341–3.
- Yang F, Kulbak G. A new trick to a routine procedure: Taking the fear out of the axillary vein stick using the 35°caudal view. Europace. 2015;17:1157–60. doi: 10.1093/europace/euv066.
Source: PubMed