Abstract
Objective To compare the efficacy of blind axillary vein puncture utilizing the new surface landmarks for the subclavian method.Methods This prospective and randomized study was performed at two cardiology medical centers in East China. Five hundred thirty-eight patients indicated to undergo left-sided pacemaker or implantable cardioverter defibrillator implantation were enrolled, 272 patients under the axillary access and 266 patients under the subclavian approach. A new superficial landmark was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. We measured lead placement time and X-ray time from vein puncture until all leads were placed in superior vena cava. Meanwhile, the rate of success of lead placement and the type and incidence of complications were compared between the two groups.Results There were no significant differences between the two groups in baseline characteristics or number of leads implanted. There were high success rates for both strategies (98.6% [494/501] vs. 98.4% [479/487], P=0.752) and similar complication rates (14% [38/272] vs. 15% [40/266], P=0.702). Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group.Conclusion We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and also allows to get this vein without the guidance of fluoroscopy, contrast, or echography.
Highlights
Central venous access is an essential step during pacemaker and implantable cardioverter defibrillator (ICD) leads implantation[1]
Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group
We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and allows to get this vein without the guidance of fluoroscopy, contrast, or echography
Summary
Central venous access is an essential step during pacemaker and implantable cardioverter defibrillator (ICD) leads implantation[1]. Since first described in the late 1960s, the subclavian approach has emerged as the most frequently performed method for implanting endocardial pacemaker and transvenous defibrillator leads[2]. A 1% to 3% incidence of pneumothorax or hemothorax has been reported in association with the subclavian access[3,4,5]. The subclavian access may result in an increased incidence of lead fracture due to entrapment of the lead by the costoclavicular ligament and/or the subclavius muscle[6,7]. Blind axillary venous access was proved to be safe by Belott[8], many physicians still cannulate central veins under tools guidance. An expert in device implantation should master every option so he or she can choose the one that fits better in every situation
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