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. 2020 Jan-Feb;20(1):21-26.
doi: 10.1016/j.ipej.2019.12.008. Epub 2019 Dec 16.

Ultrasound-guided axillary vein puncture for cardiac devices implantation in patients under antithrombotic therapy

Mohammed ElJamili  1 , Sok-Sithikun Bun  2 , Decebal Gabriel Latcu  2 , Tahar Delassi  2 , Mustapha Elhattaoui  3 , Nadir Saoudi  2
Affiliations

Ultrasound-guided axillary vein puncture for cardiac devices implantation in patients under antithrombotic therapy

Mohammed ElJamili et al. Indian Pacing Electrophysiol J. 2020 Jan-Feb.

Abstract

Background: Ultrasound-guided axillary venous puncture (UGAVP) for cardiac devices implantation has been developed because of its rapidity, safety and potential long-term lead protection. Early work excluded defibrillators (ICD), cardiac resynchronization therapy (CRT) and upgrade procedures. Compared to the cephalic approach, in previous studies, there was a greater use of pressure dressings with this technique, suggesting a higher risk of bleeding.

Aims: To assess UGAVP in patients under antithrombotic therapy (ATT) undergoing cardiac devices implantation including CRT/ICD.

Methods: Prospectively, consecutive patients eligible for a pacemaker or ICD implantation were included. All procedures were performed by a single operator, experienced with UGAVP for femoral access, and fluoroscopy-guided axillary vein access. Guidewires insertion time (from lidocaïne administration), and complications were systematically studied.

Results: From 457 cardiac device implantations, 200 patients (77.8 ± 10 y, male 58%) 360 leads were implanted by UGAVP including 36 ICD, 54 CRT and 14 upgrade procedures. A majority (90%) was under ATT: Vitamin K Antagonist or Heparin (n = 58, 29%), direct oral anticoagulant (n = 46, 23%), dual antithrombotic therapy (n = 18, 9%) and single antiplatelet drug (n = 82, 41%). UGAVP was successful in 95.78%. Mean insertion time for 1.8 guidewires per patient was 4.68 ± 3.6 min. No complication (no hematoma) was observed during the follow-up (mean of 45 ± 10 months). Guidewires insertion time reached its plateau after 15 patients.

Conclusion: UGAVP is fast, feasible and safe for patients under ATT undergoing device implantation including CRT/ICD and upgrade procedures, with a short learning curve.

Keywords: Antithrombotic therapy; Cardiac devices implantation; Ultrasound guidance; Vascular complications.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Fig. 1
Fig. 1
Fluoroscopic comparison of the course of the leads with ultrasound-guided axillary vein puncture (left image), and subclavian puncture (right image). The angulation and potential mechanical stress on the leads are significantly marked with the subclavian access (white arrow).
Fig. 2
Fig. 2
Patient installation in the catheter laboratory with position of the probe during puncture.
Fig. 3
Fig. 3
Ultrasound image of a left axillary vasculature.
Fig. 4
Fig. 4
Ultrasound-guided axillary vein puncture learning curve for devices.
See this image and copyright information in PMC

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