Ultrasound-guided Axillary Vein Puncture for Cardiac Device Implantation: A Safe and Effective Approach.

Autor:	Maffè S; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Paffoni P; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Di Nardo F; Medical Direction, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Bergamasco L; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Prenna E; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Facchini E; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Careri G; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Franchetti Pardo N; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Paino AM; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy., Dellavesa P; Division of Cardiology, SS Trinità Borgomanero Hospital, ASL NO, Novara, Italy.
Jazyk:	angličtina
Zdroj:	The Journal of innovations in cardiac rhythm management [J Innov Card Rhythm Manag] 2023 Apr 15; Vol. 14 (4), pp. 5410-5419. Date of Electronic Publication: 2023 Apr 15 (Print Publication: 2023).
DOI:	10.19102/icrm.2023.14045
Abstrakt:	Ultrasound-guided axillary vein access is an effective alternative to conventional subclavian and cephalic access for cardiac implantable electronic device implantation. The aim of this study was to compare the safety, efficacy, and radiation exposure data of the ultrasound-guided axillary approach with other conventional access techniques. The study population included 130 consecutive patients, stratified as 65 (64% male; median age, 79 years) in the study group and 65 (66% male; median age, 81 years) in the control group. We performed a retrospective not-randomized analysis by comparing ultrasound-guided axillary vein puncture with subclavian and cephalic approaches in order to test the effect on X-ray exposure, total procedure time, and complications. Significant differences were observed in terms of radiation exposure, including fluoroscopy time (median, 95 s [study group] vs. 193 s [control group]; P < .001), air kerma (median, 29 mGy [study group] vs. 55.7 mGy [control group]; P < .001), and dose-area product (median, 8219 mGy·cm 2 [study group] vs. 16736 mGy·cm 2 [control group]; P < .001). The median procedure time was 45 min in the study group but 50 min in the control group ( P < .05). Complications occurred in 6 control group patients (1 urticaria contrast medium-related, 3 pneumothorax, 2 subclavian artery puncture) and 2 study group patients (2 axillary artery puncture). We conclude that the ultrasound-guided axillary venous approach is a fast, feasible, and safe technique for cardiac lead implantation. It allows a significant reduction in fluoroscopy time without prolonging the procedural time. This approach offers direct visualization of the vessel during the puncture, so it can be useful in patients who cannot receive contrast medium, those who require "difficult" thoracic approaches (emphysema, too much or too little fat tissue), or those on anticoagulant therapy. Competing Interests: The authors report no conflicts of interest for the published content. No funding information was provided. (Copyright: © 2023 Innovations in Cardiac Rhythm Management.)
Databáze:	MEDLINE
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