Leventopoulos Georgios, Travlos Christoforos K, Theofilatos Athinagoras, Spyropoulou Panagiota, Papageorgiou Angeliki, Perperis Angelos, Koros Rafail, Moulias Athanasios, Koniari Ioanna, Davlouros Periklis
Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece.
Research Institute, McGill University Health Center, Montreal, QC H4A 3J1, Canada.
J Pers Med. 2024 Oct 31;14(11):1084. doi: 10.3390/jpm14111084.
(1) Background: Ultrasound-guided axillary (USAX) vein puncture is a relatively new method to obtain venous access for the implantation of cardiac implantable electronic devices (CIED). However, its use is limited as most of the operators are not familiar with this technique. Our aim was to investigate the safety and efficacy of the USAX compared with the traditional cephalic vein dissection for venous access in CIED implantation. (2) Methods: This was a single-center, randomized, controlled, superiority trial. A total of 114 patients were randomized (1:1 ratio) to either USAX (u/s axillary group; 59 patients) or cephalic vein access (cephalic group; 55 patients). The primary study endpoint was defined as successful placement of all leads via the chosen access. Secondary study endpoints included time from local anesthetic injection to lead advancement in the SVC, total procedure time (skin to skin), procedure-related complications and pain perception. (3) Results: USAX was superior to cephalic access in terms of primary endpoint (OR: 4.3, 95% CI: 1.3, 14.0; = 0.012). Total procedure duration was higher in the cephalic group (55.15 ± 16.62 vs. 48.35 ± 12.81 min, = 0.017) but there was neither a significant difference in fluoroscopy time ( = 0.872) nor in total radiation dose ( = 0.815). The level of pain was higher in the cephalic group ( = 0.016), while the rates of complications were similar in both groups ( > 0.05). (4) Conclusion: USAX was superior to cephalic access regarding success rate, total procedure duration and level of pain, while having no difference in complication rates.
(1) 背景：超声引导下腋静脉穿刺是一种相对较新的获取静脉通路以植入心脏植入式电子设备（CIED）的方法。然而，由于大多数操作者不熟悉该技术，其应用受到限制。我们的目的是研究与传统头静脉解剖法相比，超声引导下腋静脉穿刺在CIED植入术中获取静脉通路的安全性和有效性。(2) 方法：这是一项单中心、随机、对照、优效性试验。共114例患者按1:1比例随机分为超声引导下腋静脉穿刺组（超声腋静脉组；59例患者）或头静脉通路组（头静脉组；55例患者）。主要研究终点定义为通过所选通路成功放置所有导线。次要研究终点包括从局部麻醉注射到上腔静脉推进导线的时间、总手术时间（皮肤到皮肤）、手术相关并发症和疼痛感知。(3) 结果：在主要终点方面，超声引导下腋静脉穿刺优于头静脉通路（比值比：4.3，95%可信区间：1.3，14.0；P = 0.012）。头静脉组的总手术持续时间更长（55.15±16.62 vs. 48.35±12.81分钟，P = 0.017），但透视时间（P = 0.872）和总辐射剂量（P = 0.815）均无显著差异。头静脉组的疼痛程度更高（P = 0.016），而两组的并发症发生率相似（P>0.05）。(4) 结论：在成功率、总手术持续时间和疼痛程度方面，超声引导下腋静脉穿刺优于头静脉通路，而并发症发生率无差异。
