Why the study?
Although ultrasound guidance for axillary vein access is reliable for CIED implantation, no data were available on using handheld ultrasound devices in this setting.
Does ultrasound guidance using a handheld ultrasound device improve procedural outcomes or reduce radiation exposure compared to traditional fluoroscopic guidance for axillary vein access during CIED implantation?
Does ultrasound guidance using a handheld ultrasound device improve procedural outcomes or reduce radiation exposure compared to traditional fluoroscopic guidance for axillary vein access during CIED implantation?
Using a handheld ultrasound device for axillary vein access during CIED implantation is feasible, safe, and significantly reduces radiation exposure without prolonging procedure time.
Supports handheld ultrasound for reduced radiation in CIED access; hypothesis-generating, should not yet change practice.
Background: Although ultrasound guidance for axillary vein (AV) access (USGAVA) has been described as a reliable technique for cardiac implantable electronic device (CIED) implantation, no data is available on the use of handheld ultrasound devices (HUD) in such a setting. Objective: We investigated the feasibility of using a HUD for USGAVA in patients referred to our Institution for CIED implantation. Methods: The procedure details of 80 consecutive patients undergoing USGAVA (Group-1) from June 2020 to June 2021 were prospectively collected and compared to those of an age and sex-matched cohort of 91 patients (Group-2) who had undergone AV access with the traditional venipuncture guided by fluoroscopic landmarks. Results: The two groups were comparable for the success rate of venous access (92.5% versus 93.4%, p = 0.82), complication rate (1.3% versus 0.9%, p = 1.0), and procedure time (71 ± 32 min versus 70 ± 29 min, p = 0.9). However, Group-2 had a longer X-ray exposure time (7.6 ± 8.4 min versus 5.7 ± 7.3 min, p = 0.03). In Group-1, the univariate logistic regression analysis demonstrated that the AV diameter was associated with successful USGAVA (odds ratio = 3.34, 95% confidence interval 1.47–7.59, p < 0.01), with a 3-fold increase of probability of success per each 1 mm increase in the AV diameter. Conclusions: USGAVA using a HUD for CIED implantation is a feasible, effective, and safe technique; moreover, it saves X-ray exposure time without lengthening the implant procedure time.
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Sassone et al. (2022) studied this question.
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