title: Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access.
abstract: OBJECTIVE
  Axillary vein access for pacemaker implantation is uncommon in many centres because of the lack of training in this technique. We assessed whether the introduction of the axillary vein technique was safe and efficient as compared with cephalic vein access, in a centre where no operators had any previous experience in axillary vein puncture.
  
  
  RESULTS
  Patients undergoing pacemaker implantation were randomized to axillary or cephalic vein access. All three operators had no experience nor training in axillary vein puncture, and self-learned the technique by reading a published review. Axillary vein puncture was fluoroscopy-guided without contrast venography. Cephalic access was performed by dissection of delto-pectoral groove. Venous access success, venous access duration (from skin incision to guidewire or lead in superior vena cava), procedure duration, X-ray exposure, and peri-procedural (1 month) complications were recorded. results We randomized 74 consecutive patients to axillary (n = 37) or cephalic vein access (n = 37). Axillary vein was successfully accessed in 30/37 (81.1%) patients vs. 28/37 (75.7%) of cephalic veins (P = 0.57). Venous access time was shorter in axillary group than in cephalic group [5.7 (4.4-8.3) vs. 12.2 (10.5-14.8) min, P < 0.001], as well as procedure duration [34.8 (30.6-38.4) vs. 42.0 (39.1-46.6) min, P = 0.043]. X-ray exposure and peri-procedural overall complications were comparable in both groups. Axillary puncture was safe and faster than cephalic access even for the five first procedures performed by each operator.
  
  
  CONCLUSIONS
  Self-taught axillary vein puncture for pacemaker implantation seems immediately safe and faster than cephalic vein access, when performed by electrophysiologists trained to pacemaker implantation but not to axillary vein puncture.
authors.affiliation: Cardiology Department, Pasteur University Hospital, 30 Avenue De La Voie Romaine, 06000 Nice, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Squara
authors.affiliation: Cardiology Department, Pasteur University Hospital, 30 Avenue De La Voie Romaine, 06000 Nice, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Tomi
authors.affiliation: Cardiology Department, Pasteur University Hospital, 30 Avenue De La Voie Romaine, 06000 Nice, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Scarlatti
authors.affiliation: Cardiology Department, Pasteur University Hospital, 30 Avenue De La Voie Romaine, 06000 Nice, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Theodore
authors.affiliation: Cardiology Department, Pasteur University Hospital, 30 Avenue De La Voie Romaine, 06000 Nice, France.
authors.forename: Pamela
authors.initials: P
authors.lastname: Moceri
authors.affiliation: Cardiology Department, Pasteur University Hospital, 30 Avenue De La Voie Romaine, 06000 Nice, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Ferrari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001367:Axillary Vein / Q000000981:diagnostic imaging; D002304:Cardiac Pacing, Artificial; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D005602:France; D006801:Humans; D059032:Learning Curve; D008297:Male; D010138:Pacemaker, Artificial; D010690:Phlebography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011677:Punctures; D000069079:Radiation Exposure; D015641:Radiography, Interventional; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Axillary vein; Cephalic vein; Pacemaker