Key result
Ultrasound-guided axillary access for CIEDs finds the vein and artery horizontally aligned in 96% of cases.
Why the study?
Axillary vein access for CIED implantation is recommended as a safer approach, and ultrasound guidance may help define the anatomical relationships among the axillary vein, artery, and pleural line within the Mohrenheim fossa.
Cohort (n=719)
Ultrasound-guided axillary access for CIED implantation reveals that nearly 5% of patients have overlapping vessel distributions that may increase the risk of arterial puncture during traditional fluoroscopy-guided access.
Answers are grounded in this paper and cite their sources.
Supports standard axillary access planning; leaves open prospective validation of safety by anatomic variant.
Background Axillary vein access for CIED implantation is suggested by the guidelines as a safer approach. Ultrasound (US) guided axillary access may also help to define the relationships among axillary vein and artery and the pleural line within the Mohrenheim fossa. Methods From October 2021 to October 2024, 719 consecutive patients (mean age 79.6 +/- 11 y; 480 male) underwent CIED implantation by using an axillary access during the following CIED procedures: PMDR 398 (55.3%); PMVR 154 (21.4%); CRTP 10 (1.4%) CRTD 51 (7%) ICD 93 (13 %) CIED revision 13 (1.8%). Patients with a subclavian or cephalic approaches were excluded. Among them, 395/719 (55%, 265 male) underwent to US guided approach with a phased array probe. Results The vessels distribution has been classified as follows: type 1, found in 376/395 (96%) cases with the axillary vein and artery on the same horizontal plane, but with the vein medially located; type 2A, found in 5/395 (1.2%) cases, with axillary artery and vein superiorly and inferiorly, respectively located (artery over); and type 2B found in 14 (3.5%) cases with the opposite distribution (vein over). In 2 cases a PNX occurred; both patients underwent a subclavian approach after an axillary failed access. Conclusions An US guided axillary access during CIED implantation, may help to define the vessel distribution. The type 2A and 2B cases may be at risk of arterial puncture/cannulation when using a fluoroscopic axillary access, due to vessels’ overlap. The direct visualization of the "pleural line" may enhance safety.
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Zoppo et al. (2026) conducted a cohort in CIED implantation (n=719). Ultrasound-guided axillary access was evaluated on Anatomical distribution of axillary vessels. Among patients undergoing ultrasound-guided axillary access for CIED implantation, the axillary vein and artery were on the same horizontal plane in 96% of cases.
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