Ultrasound-guided Axillary Vein Puncture in Cardiac Lead Implantation: Time to Move to a New Standard Access?

Ana Paula Tagliari; Adriano Nunes Kochi; Bernardo Mastella; Rodrigo Petersen Saadi; Andres di Leoni Ferrari; Luiz Henrique Dussin; Leandro de Moura; Márcio Rodrigo Martins; Eduardo Keller Saadi; Carisi Anne Polanczyk

doi:10.15420/aer.2020.17

Ultrasound-guided Axillary Vein Puncture in Cardiac Lead Implantation: Time to Move to a New Standard Access?

Arrhythm Electrophysiol Rev. 2020 Aug;9(2):78-82. doi: 10.15420/aer.2020.17.

Authors

Ana Paula Tagliari^{1

2

3}, Adriano Nunes Kochi^{1

4

5}, Bernardo Mastella⁶, Rodrigo Petersen Saadi⁶, Andres di Leoni Ferrari², Luiz Henrique Dussin^{2

6}, Leandro de Moura^{2

6}, Márcio Rodrigo Martins^{2

6}, Eduardo Keller Saadi^{2

6}, Carisi Anne Polanczyk^{1

7}

Affiliations

¹ Postgraduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
² Cardiovascular Surgery Department, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
³ University Hospital of Zurich, University of Zurich, Cardiac Surgery Department, Zurich, Switzerland.
⁴ Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.
⁵ Centro Cardiologico Monzino, Heart Rhythm Center, Milan, Italy.
⁶ Cardiovascular Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
⁷ Cardiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.

Abstract

Cardiac stimulation therapy has evolved significantly over the past 30 years. Currently, cardiac implantable electronic devices (CIED) are the mainstream therapy for many potentially lethal heart conditions, such as advanced atrioventricular block or sustained ventricular tachycardia or fibrillation. Despite sometimes being lifesaving, the implant is surgical and therefore carries all the inevitable intrinsic risks. In the process of technology evolution, one of the most important factors is to make it safer for the patient. In the context of CIED implants, complications include accidental puncture of intrathoracic structures. Alternative strategies to intrathoracic subclavian vein puncture include cephalic vein dissection or axillary vein puncture, which can be guided by fluoroscopy, venography or, more recently, ultrasound. In this article, the authors analyse the state of the art of ultrasound-guided axillary vein puncture using evidence from landmark studies in this field.

Keywords: Cardiac implantable electronic devices; ICD; axillary vein; permanent pacemaker implantation; ultrasound.

Publication types

Review