Ultrasound-guided axillary vein puncture for cardiac devices implantation in patients under antithrombotic therapy
| Autor: | Mustapha Elhattaoui, Sok-Sithikun Bun, Nadir Saoudi, Mohammed Eljamili, T. Delassi, Decebal Gabriel Latcu |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty Antiplatelet drug Lidocaine medicine.drug_class medicine.medical_treatment Cardiac resynchronization therapy Cardiac devices implantation 030204 cardiovascular system & hematology Ultrasound guidance 03 medical and health sciences 0302 clinical medicine Hematoma Physiology (medical) Antithrombotic medicine 030212 general & internal medicine Antithrombotic therapy business.industry Vascular complications Vitamin K antagonist medicine.disease Surgery lcsh:RC666-701 Original Article Cardiology and Cardiovascular Medicine Complication Axillary vein business medicine.drug |
| Zdroj: | Indian Pacing and Electrophysiology Journal, Vol 20, Iss 1, Pp 21-26 (2020) Indian Pacing and Electrophysiology Journal |
| ISSN: | 0972-6292 |
| DOI: | 10.1016/j.ipej.2019.12.008 |
| Popis: | Background: Ultrasound-guided axillary venous puncture (UGAVP) for cardiac devices implantation has been developed because of its rapidity, safety and potential long-term lead protection. Early work excluded defibrillators (ICD), cardiac resynchronization therapy (CRT) and upgrade procedures. Compared to the cephalic approach, in previous studies, there was a greater use of pressure dressings with this technique, suggesting a higher risk of bleeding. Aims: To assess UGAVP in patients under antithrombotic therapy (ATT) undergoing cardiac devices implantation including CRT/ICD. Methods: Prospectively, consecutive patients eligible for a pacemaker or ICD implantation were included. All procedures were performed by a single operator, experienced with UGAVP for femoral access, and fluoroscopy-guided axillary vein access. Guidewires insertion time (from lidocaïne administration), and complications were systematically studied. Results: From 457 cardiac device implantations, 200 patients (77.8 ± 10 y, male 58%) 360 leads were implanted by UGAVP including 36 ICD, 54 CRT and 14 upgrade procedures. A majority (90%) was under ATT: Vitamin K Antagonist or Heparin (n = 58, 29%), direct oral anticoagulant (n = 46, 23%), dual antithrombotic therapy (n = 18, 9%) and single antiplatelet drug (n = 82, 41%). UGAVP was successful in 95.78%. Mean insertion time for 1.8 guidewires per patient was 4.68 ± 3.6 min. No complication (no hematoma) was observed during the follow-up (mean of 45 ± 10 months). Guidewires insertion time reached its plateau after 15 patients. Conclusion: UGAVP is fast, feasible and safe for patients under ATT undergoing device implantation including CRT/ICD and upgrade procedures, with a short learning curve. Keywords: Cardiac devices implantation, Vascular complications, Ultrasound guidance, Antithrombotic therapy |
| Databáze: | OpenAIRE |
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