Optimized Axillary Vein Technique versus Subclavian Vein Technique in Cardiovascular Implantable Electronic Device Implantation: A Randomized Controlled Study.
BACKGROUND
The conventional venous access for cardiovascular implantable electronic device (CIED) is the subclavian vein, which is often accompanied by high complication rate. The aim of this study was to assess the efficacy and safety of optimized axillary vein technique.


METHODS
A total of 247 patients undergoing CIED implantation were included and assigned to the axillary vein group or the subclavian vein group randomly. Success rate of puncture and complications in the perioperative period and follow-ups were recorded.


RESULTS
The overall success rate (95.7% vs. 96.0%) and one-time success rate (68.4% vs. 66.1%) of punctures were similar between the two groups. In the subclavian vein group, pneumothorax occurred in three patients. The subclavian gaps of three patients were too tight to allow operation of the electrode lead. In contrast, there were no puncture-associated complications in the axillary vein group. In the patient follow-ups, two patients in the subclavian vein group had subclavian crush syndrome and both of them received lead replacement. The incidence of complications during the perioperative period and follow-ups of the axillary vein group and the subclavian vein group was 1.6% (2/125) and 8.2% (10/122), respectively (χ2 = 5.813, P = 0.016).


CONCLUSIONS
Optimized axillary vein technique may be superior to the conventional subclavian vein technique for CIED lead placement.


BACKGROUND
www.clinicaltrials.gov, NCT02358551; https://clinicaltrials.gov/ct2/show/NCT02358551?term=NCT02358551& rank=1.
Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Peng
P
Liu
Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Yi-Feng
YF
Zhou
Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Peng
P
Yang
Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Yan-Sha
YS
Gao
Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Gui-Ru
GR
Zhao
Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Shi-Yan
SY
Ren
Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Xian-Lun
XL
Li
D000368:Aged; D001367:Axillary Vein; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D019990:Perioperative Care; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000009:adverse effects; D013350:Subclavian Vein