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
Figure 1
Axillary vein puncture. The arrow indicates the puncture site.
Figure 2
Figure 2
Cubital vein angiography. The passages of axillary vein and subclavian vein can be observed. The left arrow indicates the axillary vein and the right arrow indicates the subclavian vein.

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Source: PubMed

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