Nikorowitsch Julius, Üctas Tahsin, Borof Katrin, Metzner Andreas, Wenzel Jan-Per, Winkelmann Simon Julius, Pecha Simon, Yildirim Yalin, Reichenspurner Hermann, Kirchhof Paulus, Tönnis Tobias, Becher Nina
Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
Clin Res Cardiol. 2025 Jun 24. doi: 10.1007/s00392-025-02692-7.
Central venous access for cardiac implantable electronic device (CIED) implantations is conventionally acquired via the cephalic or subclavian vein. Controlled data suggest that axillary vein access may reduce complications.
We, therefore, shifted institutional practice from subclavian vein access to ultrasound (US)-guided axillary vein access for new implantations and revisions or upgrades and report on implant success rates, learning curves and periprocedural complications.
Between January 2021 and August 2023, all patients undergoing CIED implantations, revisions or upgrades were analyzed. US-guided axillary access was introduced starting with one operator and spreading to most operators and trainees thereafter. Periprocedural outcomes and complications (pocket hematoma, hemothorax, and pneumothorax) of transcutaneous US-guided axillary vein access were compared to the subclavian vein access.
In this study, 986 patients (median age: 75 years, interquartile range (IQR) 64-82 years, 35% women) with 87% new implantations and 13% revisions or upgrades were included. Transcutaneous US-guided axillary access was successful in 535/578 patients (93%), subclavian vein access in 400/408 patients (98%) (p < 0.001). For device upgrades or revisions specifically, axillary access was successful in 69/79 patients (87%), versus 45/47 patients (96%) with subclavian access (p = 0.208). The learning curve for axillary access was steep with success rates of 93 after 30 cases per operator. Complications occurred in 2/578 patients (0.3%) undergoing axillary vein access versus 17/408 patients (4.2%) (p < 0.001) undergoing subclavian vein access.
The implementation of transcutaneous US-guided axillary vein access for implantation, revisions and upgrades of cardiac electronic devices is feasible in a large tertiary care center. The periprocedural complications are rare.
心脏植入式电子设备（CIED）植入术的中心静脉通路传统上是通过头静脉或锁骨下静脉获得的。对照数据表明，腋静脉通路可能会减少并发症。
因此，我们将机构的操作方式从锁骨下静脉通路转变为超声（US）引导下的腋静脉通路用于新植入以及修订或升级手术，并报告植入成功率、学习曲线和围手术期并发症情况。
对2021年1月至2023年8月期间所有接受CIED植入、修订或升级手术的患者进行分析。超声引导下的腋静脉通路从一名操作人员开始引入，之后推广到大多数操作人员和实习生。将经皮超声引导下腋静脉通路的围手术期结果和并发症（囊袋血肿、血胸和气胸）与锁骨下静脉通路进行比较。
本研究纳入了986例患者（中位年龄：75岁，四分位间距（IQR）64 - 82岁，35%为女性），其中87%为新植入手术，13%为修订或升级手术。经皮超声引导下腋静脉通路在535/578例患者中成功（93%），锁骨下静脉通路在400/408例患者中成功（98%）（p < 0.001）。对于特定的设备升级或修订手术，腋静脉通路在69/79例患者中成功（87%），而锁骨下静脉通路在45/47例患者中成功（96%）（p = 0.208）。腋静脉通路的学习曲线较陡，每位操作人员在30例手术后成功率为93%。接受腋静脉通路的2/578例患者（0.3%）发生并发症，而接受锁骨下静脉通路的17/408例患者（4.2%）发生并发症（p < 0.001）。
在大型三级医疗中心，经皮超声引导下腋静脉通路用于心脏电子设备的植入、修订和升级手术是可行的。围手术期并发症很少见。
