Why the study?
To review the benefits and hazards of different central vein access approaches for cardiac implantable electronic device insertion to determine the optimal access technique.
What is the optimal access technique (ultrasound guidance, venography, or cephalic cutdown) for insertion of pacing leads?
What is the optimal access technique (ultrasound guidance, venography, or cephalic cutdown) for insertion of pacing leads?
Ultrasound guidance is highlighted as a mainstream option for central vein access during CIED insertion due to its safety profile.
Individual patient and operator factors should guide CIED vein access choice; leaves open optimal technique without randomized comparisons.
We reviewed the different approaches used for central vein access during insertion of cardiac implantable electronic devices. The benefits and hazards of each approach (cephalic vein cutdown, axillary vein cannulation using venography and ultrasound) are discussed. Each approach has its advantages and hazards that need to be considered for the individual patient and balanced against the skills of the operator. The benefits of ultrasound guided venous access in reducing radiation exposure to the patient and implanter, avoiding the need for angiographic contrast and in minimizing the risk of pneumothorax and inadvertent arterial puncture are highlighted. Trainees should be taught each approach to deal with patient variability. Ultrasound guidance should be considered as a mainstream option for most patients.
No takes yet. Share an insight, caveat, or question.
Davis et al. (2021) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: