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Efficacy of ultrasound-guided axillary/subclavian venous approaches for pacemaker and defibrillator lead implantation: a randomized study

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Abstract

Purpose

Subclavian access is a reliable technique for lead insertion in pacemaker and defibrillator (ICD) implantation, but it is often accompanied by complications. The aim of this study was to compare the efficacy of the ultrasound-guided axillary approach to the subclavian method.

Methods

This randomized comparative study was performed on 174 patients: as a first attempt, 116 patients underwent the ultrasound-guided axillary access and 58 patients underwent the subclavian approach. A total of 364 leads were placed. Operators were trained in ultrasound-guided vein access technique.

Results

Axillary access was successful in 69% of patients (32/46), in the training phase and, as a first attempt, in 91.4% of patients (106/116), in the randomized phase. When axillary approach failed, we performed the following: subclavian access in 5.2% of patients (6/116), cephalic approach in 2.6% of patients (3/116), surgical method in 0.9% of patients (1/116). The subclavian technique was effective, as a first attempt, in 55 patients (94.8%). When the subclavian access failed, the ultrasound axillary approach successfully performed in all three cases. During a mean follow-up of 18 ± 6 months, the number of lead complications was similar in the subclavian group compared to the axillary group (p = 0.664).

Conclusions

As first attempt, ultrasound-guided axillary method showed similarly high-success rate than subclavian approach and well performed when the first attempt in subclavian group failed. Axillary access can be considered a safe and effective alternative technique to the conventional subclavian method for device implantation.

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References

  1. Littleford PO, Parsonnet V, Spector SD. Method for the rapid and atraumatic insertion of permanent endocardial pacemaker electrodes through the subclavian vein. Am J Cardiol. 1979;43(5):980–2. https://doi.org/10.1016/0002-9149(79)90363-1.

    Article  CAS  PubMed  Google Scholar 

  2. Aggarwal RK, Connelly DT, Ray SG, Ball J, Charles RG. Early complications of permanent pacemaker implantation. Br Heart J. 1995;73(6):571–5. https://doi.org/10.1136/hrt.73.6.571.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Chauhan A, Grace AA, Newell SA, Stone DL, Shapiro LM, Schofield PM, et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol. 1994;17(Pt. II):2012–3.

    Article  CAS  PubMed  Google Scholar 

  4. Kazama S, Nishiyama K, Machii M. Long term follow up of ventricular endocardial pacing leads. Jpn Heart J. 1993;34(2):193–200. https://doi.org/10.1536/ihj.34.193.

    Article  CAS  PubMed  Google Scholar 

  5. Alt E, Volker R, Blomer H. Lead fracture in pacemaker patients. Thorac Cardiovasc Surg. 1987;35(02):101–4. https://doi.org/10.1055/s-2007-1020206.

    Article  CAS  PubMed  Google Scholar 

  6. Antonelli D, Rosenfeld T, Freedberg NA, Palma E, Gross JN, Furman S. Insulation lead failure: is it a matter of insulation coating, venous approach, or both? Pacing Clin Electrophysiol. 1998;21(2):418–21. https://doi.org/10.1111/j.1540-8159.1998.tb00066.x.

    Article  CAS  PubMed  Google Scholar 

  7. 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. https://doi.org/10.1016/j.ijcard.2015.07.055.

    Article  PubMed  Google Scholar 

  8. Belott P. How to access the axillary vein. Heart Rhythm. 2006;3(3):366–9. https://doi.org/10.1016/j.hrthm.2005.10.031.

    Article  PubMed  Google Scholar 

  9. 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(5):542–6. https://doi.org/10.1016/j.cjca.2012.02.019.

    Article  PubMed  Google Scholar 

  10. 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):456–64. https://doi.org/10.1046/j.1460-9592.2001.00456.x.

    Article  CAS  PubMed  Google Scholar 

  11. Gardini A, Benedini G. Blind extrathoracic subclavian venipuncture for pacemaker implant: a 3-year experience in 250 patients. Pacing Clin Electrophysiol. 1998;21(11):2304–8. https://doi.org/10.1111/j.1540-8159.1998.tb01171.x.

    Article  CAS  PubMed  Google Scholar 

  12. Migliore F, Siciliano M, De Lazzari M, Ferretto S, Valle CD, Zorzi A, et al. Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads. J Interv Card Electrophysiol. 2015;43(3):263–7. https://doi.org/10.1007/s10840-015-0011-7.

    Article  PubMed  Google Scholar 

  13. Sommerkamp SK, Romaniuk VM, Witting MD, Ford DR, Allison MG, Euerle BD. A Comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation. Am J Emerg Med. 2013;3:478–81.

    Article  Google Scholar 

  14. Esmaiel A, Hassan J, Blenkhorn F, Mardigyan V. The use of ultrasound to improve axillary vein access and minimize complications during pacemaker implantation. Pacing Clin Electrophysiol. 2016;39(5):478–82. https://doi.org/10.1111/pace.12833.

    Article  PubMed  Google Scholar 

  15. Yaminisharif A, Soofizadeh N, Shafiee A, Kazemisaeid A, Jalali A, Vasheghani-Farahani A. Generator and lead-related complications of implantable cardioverter defibrillators. Int Cardiovasc Res J. 2014;8(2):66–70.

    PubMed  PubMed Central  Google Scholar 

  16. 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(9):1107–10. https://doi.org/10.1111/pace.12181.

    Article  PubMed  Google Scholar 

  17. Ramza BM, Rosenthal L, Hui R, Nsah E, Savader S, Lawrence JH, et al. Safety and effectiveness of placement of pacemaker and defibrillator lead in the axillary vein guided by contrast venography. Am J Cardiol. 1997;80(7):892–6. https://doi.org/10.1016/S0002-9149(97)00542-0.

    Article  CAS  PubMed  Google Scholar 

  18. Byrd C. Clinical experience with the extrathoracic introducer insertion technique. Pacing Clin Electrophysiol. 1993;16(9):1781–4. https://doi.org/10.1111/j.1540-8159.1993.tb01810.x.

    Article  CAS  PubMed  Google Scholar 

  19. Nickalls RW. A New percutaneous infraclavicular approach to the axillary vein. Anaesthesia. 1987;42(2):151–4. https://doi.org/10.1111/j.1365-2044.1987.tb02988.x.

    Article  CAS  PubMed  Google Scholar 

  20. Migliore F, Curnis A, Bertaglia E. Axillary vein technique for pacemaker and implantable defibrillator leads implantation: a safe and alternative approach. J Cardiovasc Med (Hagerstown). 2016;17(4):309–13. https://doi.org/10.2459/JCM.0000000000000154.

    Article  CAS  Google Scholar 

  21. Seto AH, Jolly A, Salcedo J. Ultrasound-guided venous access for pacemakers and defibrillators. J Cardiovasc Electrophysiol. 2013;24(3):370–4. https://doi.org/10.1111/jce.12005.

    Article  PubMed  Google Scholar 

  22. Sharma A, Bodenham AR, Mallick A. Ultrasound-guided infraclavicular axillary vein cannulation for central venous access. Br J Anaesth. 2004;93(2):188–92. https://doi.org/10.1093/bja/aeh187.

    Article  CAS  PubMed  Google Scholar 

  23. Orihashi K, Imai K, Sato K, Hamamoto M, Okada K, Sueda T. Extrathoracic subclavian venipuncture under ultrasound guidance. Circ J. 2005;69(9):1111–5. https://doi.org/10.1253/circj.69.1111.

    Article  PubMed  Google Scholar 

  24. Harada Y, Katsume A, Kimata M, Hikosaka T, Yamanaka S, Akashi K, et al. Placement of pacemaker leads via the extrathoracic subclavian vein guided by fluoroscopy and venography in the oblique projection. Heart Vessel. 2005;20(1):19–22. https://doi.org/10.1007/s00380-004-0797-1.

    Article  Google Scholar 

  25. Jones DG, Stiles MK, Stewart JT, Armstrong GP. Ultrasound-guided venous access for permanent pacemaker leads. Pacing Clin Electrophysiol. 2006;29(8):852–7. https://doi.org/10.1111/j.1540-8159.2006.00451.x.

    Article  PubMed  Google Scholar 

  26. Franco E, Muñoz DR, Matìa 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(4):482–7. https://doi.org/10.1111/jce.12917.

    Article  PubMed  Google Scholar 

  27. Kim KH, Park KM, Nam GB, Kim DK, Oh M, Choi H, et al. Comparison of the axillary venous approach and subclavian venous approach for efficacy of permanent pacemaker implantation—8-year follow-up results. Circ J. 2014;78(4):865–71. https://doi.org/10.1253/circj.CJ-13-0884.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Ospedale San Giuliano, Via Giambattista Basile, 25, 80014, Giugliano in Campania, NA, Italy

    Mattia Liccardo

  2. Presidio Ospedaliero S. Maria Delle Grazie, Via Domitiana. Località La Schiana, 80078, Pozzuoli, NA, Italy

    Pasquale Nocerino

  3. Boston Scientific Corporation, Marlborough, MA, USA

    Salzano Gaia

  4. HT MED, II Traversa Coste Agnano, 18, 80078, Pozzuoli, NA, Italy

    Carmine Ciardiello

Authors
  1. Mattia Liccardo
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  2. Pasquale Nocerino
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  3. Salzano Gaia
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  4. Carmine Ciardiello
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Corresponding author

Correspondence to Carmine Ciardiello.

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Conflict of interest

Gaia Salzano is an employee of Boston Scientific, Inc. No other conflicts of interest exist.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

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Liccardo, M., Nocerino, P., Gaia, S. et al. Efficacy of ultrasound-guided axillary/subclavian venous approaches for pacemaker and defibrillator lead implantation: a randomized study. J Interv Card Electrophysiol 51, 153–160 (2018). https://doi.org/10.1007/s10840-018-0313-7

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  • DOI: https://doi.org/10.1007/s10840-018-0313-7

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