Feasibility of ultrasound-guided vascular access during cardiac implantable device placement.

Abstract

Ultrasound (US)-guided access for venous catheter placement has previously been shown to improve success rates and decrease access-related complications. The purpose of this study was to determine the feasibility of US-guided versus traditional vascular access approaches during implantation of cardiac implantable electronic devices (CIEDs). We evaluated outcomes for 816 consecutive patients undergoing new CIED implantation between May 2013 and April 2016 at a single institution with respect to use of US guidance for vascular access (137 with US guidance versus 679 with traditional access techniques). The primary outcome was a composite of procedural complications including deep vein thrombosis, pneumothorax, or hematoma. There was no cross-over between US guidance and traditional access. The overall complication rate was 3.6% (2.2% in US, 3.8% in non-US). The use of US was associated with a decrease in fluoroscopy time (r=-0.17, p<0.01) but not the primary outcome (r=0.03, p=0.34). In models adjusted for age and number of leads, use of US was non-significantly associated with a change in fluoroscopy time (beta=-0.20, p=0.7). In logistic models adjusted for age and number of leads, use of US was associated with a trend toward reduced major complications (OR=0.57, 95% CI 0.17-1.91, p=0.36). US-guided vascular access for CIED implantation is safe and effective compared to traditional approaches with a non-significant reduction in both fluoroscopy time and procedural complications.