What is the clinical evidence from this study?

Study design: RCT. Population: Placement of pacemaker or implantable defibrillator leads (n=50). Intervention: Medial approach to axillary vein access vs. Lateral approach to axillary vein access. Primary outcome: Initial success of lead placement.

What question did this study set out to answer?

To evaluate the safety and efficacy of contrast-guided axillary vein puncture using a 5Fr micropuncture introducer set for placing pacemaker and implantable defibrillator leads.

October 1, 1997The American Journal of CardiologyOpen Access

Safety and Effectiveness of Placement of Pacemaker and Defibrillator Leads in the Axillary Vein Guided by Contrast Venography

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Key result

Medial axillary venipuncture achieves 100% initial lead placement success versus the lateral approach.

n=50

Why the study?

Does a medial approach improve success rates compared to a lateral approach for contrast-guided axillary vein lead placement in patients needing pacemakers or defibrillators?

Population

50 patients undergoing an attempt at placement of pacemaker or implantable defibrillator leads via the…

Comparison

Contrast-guided venipuncture of the axillary… vs Contrast-guided venipuncture of the axillary…

Design

RCT, Randomized into 2 groups based on whether the initial attempt at axillary…

Authors

BRBrian CM RamzaJohns Hopkins University LRLawrence RosenthalAmerican Cancer Society RHRichard HuiJohns Hopkins University

Discussion

Member takes

Implication

Medial approach should be prioritized for contrast-guided axillary access; confirms higher initial success versus lateral in this RCT.

Key Points

To evaluate the safety and efficacy of contrast-guided axillary vein puncture using a 5Fr micropuncture introducer set for placing pacemaker and implantable defibrillator leads.
Randomized trial evaluating 50 patients undergoing endocardial pacemaker or implantable cardioverter-defibrillator lead placement.
Patients were randomized to initial axillary vein puncture attempts located either medial or lateral to the rib cage margin guided by contrast venography.
Lead placement succeeded overall in 49 of 50 patients, with initial success achieved in 25 of 25 patients (100%) in the medial group compared with 18 of 24 patients (75%) in the lateral group.
All 6 patients who failed the initial lateral attempt achieved successful lead placement using the medial approach.
The medial approach yielded shorter procedure times, required fewer contrast injections, and required fewer extra guidewires, with zero major complications reported across both groups.

Study Design

Type

RCT (n=50)

Randomization

randomized

Structured PICO

Does a medial approach improve success rates compared to a lateral approach for contrast-guided axillary vein lead placement in patients needing pacemakers or defibrillators?

Population

50 patients undergoing placement of pacemaker or implantable defibrillator leads via the axillary vein using contrast-guided venipuncture.

Intervention

Contrast-guided venipuncture of the axillary vein using a medial approach to the rib cage margin with a 5Fr micropuncture introducer set

Comparator

Contrast-guided venipuncture of the axillary vein using a lateral approach to the rib cage margin

Outcome

Initial success rate of lead placement

Main Result

Absolute Event Rate: 100% vs 75%

The medial approach for contrast-guided axillary vein venipuncture yields a higher initial success rate and is more efficient than the lateral approach for endocardial lead placement.

Cite This Study

Ramza et al. (1997) conducted an RCT in Placement of pacemaker or implantable defibrillator leads (n=50). Medial approach to axillary vein access vs. Lateral approach to axillary vein access was evaluated on Initial success of lead placement. The medial approach for contrast-guided venipuncture of the axillary vein achieved a 100% initial success rate for lead placement, compared to 75% with the lateral approach.

synapsesocial.com/papers/6aa17daecab39939783c77d5 https://doi.org/10.1016/s0002-9149(97)00542-0

Topics

Cardiac device therapy

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Safety and Effectiveness of Placement of Pacemaker and Defibrillator Leads in the Axillary Vein Guided by Contrast Venography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Safety and Effectiveness of Placement of Pacemaker and Defibrillator Leads in the Axillary Vein Guided by Contrast Venography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

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