Key result
Novel landmark-guided blind axillary puncture matches subclavian success while eliminating pneumothorax and crush syndrome.
Why the study?
The study was conducted to compare the efficacy of blind axillary vein puncture utilizing new surface landmarks against the subclavian method.
Does blind axillary vein puncture using new surface landmarks improve procedural safety and efficacy compared to subclavian vein puncture in patients undergoing pacemaker or ICD implantation?
RCT (n=538)
Open-label
Simple randomization
Yes
Does blind axillary vein puncture using new surface landmarks improve procedural safety and efficacy compared to subclavian vein puncture in patients undergoing pacemaker or ICD implantation?
Blind axillary vein puncture using new surface landmarks is as effective as the subclavian approach but safer, eliminating the risk of pneumothorax and subclavian crush syndrome without requiring imaging guidance.
Supports blind axillary puncture to avoid pneumothorax and crush syndrome; confirms comparable efficacy to subclavian access in an RCT.
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.
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Shi et al. (2020) conducted an RCT in Indication for left-sided pacemaker or implantable cardioverter defibrillator implantation (n=538). Blind axillary vein puncture utilizing new surface landmarks vs. Subclavian vein approach using conventional landmarks was evaluated on Successful puncture rate (p=0.752). Blind axillary vein puncture using new surface landmarks achieved a 98.6% success rate, comparable to the subclavian approach (98.4%, P=0.752), while eliminating pneumothorax and subclavian vein crush syndrome.
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