Implementation of transcutaneous ultrasound-guided axillary vein access for implantations, revisions and upgrades of cardiac implantable electronic devices in a large tertiary care center.

IF 3.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Julius Nikorowitsch, Tahsin Üctas, Katrin Borof, Andreas Metzner, Jan-Per Wenzel, Simon Julius Winkelmann, Simon Pecha, Yalin Yildirim, Hermann Reichenspurner, Paulus Kirchhof, Tobias Tönnis, Nina Becher
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引用次数: 0

Abstract

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

在一家大型三级医疗中心实施经皮超声引导的腋静脉植入、心脏植入电子设备的修订和升级。
背景:心脏植入式电子装置(CIED)植入的中心静脉通道通常通过头静脉或锁骨下静脉获得。对照数据表明,腋静脉通路可减少并发症。目的:因此,我们将机构实践从锁骨下静脉通道转移到超声(US)引导下的腋静脉通道,用于新的植入物和修改或升级,并报告植入物成功率、学习曲线和围手术期并发症。方法:分析2021年1月至2023年8月期间所有接受CIED植入、修改或升级的患者。从一名操作员开始,采用了美国引导的腋窝通道,此后扩展到大多数操作员和学员。我们比较了经皮us引导下腋窝静脉入路与锁骨下静脉入路的围手术期结局和并发症(口袋血肿、血胸和气胸)。结果:本研究纳入986例患者(中位年龄:75岁,四分位数范围(IQR) 64-82岁,35%为女性),其中87%为新种植体,13%为修复或升级。经皮us引导下的腋静脉通道在535/578例患者中(93%)获得成功,在400/408例患者中(98%)获得成功(p结论:在大型三级医疗中心实施经皮us引导下的腋静脉通道用于心脏电子装置的植入、翻修和升级是可行的。围手术期并发症是罕见的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Research in Cardiology
Clinical Research in Cardiology 医学-心血管系统
CiteScore
11.40
自引率
4.00%
发文量
140
审稿时长
4-8 weeks
期刊介绍: Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.
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