Ultrasound-Guided Axillary Vein Puncture Versus Cephalic Vein Cutdown as Venous Access Approach for Implantation of Cardiac Implantable Electronic Devices

Cardiac implantable electronic devices (CIEDs) are integral to the management of various cardiac conditions, and different venous approaches have been utilized for their implantation. Ultrasound-guided axillary vein puncture (US-AVP) has recently emerged as a novel venous access technique. This meta-analysis aims to systematically compare venous access approaches with respect to procedural success and complication rates. The primary endpoint was the success rate, defined as the successful placement of the CIED. Secondary endpoints included time to venous access, fluoroscopy time, and any peri- or postprocedural complications. Statistical analysis was performed using Review Manager (RevMan, Cochrane Collaboration). Pooled results demonstrated a significantly higher success rate with axillary venous access compared to the cephalic vein approach (RR: 1.33; 95% CI: 1.09-1.62). Although the time to venous access was shorter for US-AVP (SMD: -17.49; 95% CI: -36.37 to 1.40; P = 0.07), this did not reach statistical significance and varied depending on the comparator group. Fluoroscopy time also favored axillary access, with a pooled estimate of -2.30 minutes (95% CI: -4.68 to 0.07; Z = 1.90, P = 0.06). Complication rates differed between groups, with a higher incidence of pneumothorax, hemothorax, hematoma formation, and infections in the nonaxillary group. In conclusion, US-AVP demonstrates superiority over conventional venous access methods for CIED implantation. It significantly improves vascular access, often the most challenging and complication-prone step in the procedure. Therefore, US-AVP should be recommended as a preferred technique in clinical practice.