Ultrasound-guided versus Fluoro-guided Axillary Venous Access for Cardiac Implantable Electronic Devices: A Patient-Based Meta-analysis.
Axillary venous access
ICD
Pacemaker
Ultrasound
Venous access
Journal
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092
Titre abrégé: Europace
Pays: England
ID NLM: 100883649
Informations de publication
Date de publication:
29 Oct 2024
29 Oct 2024
Historique:
received:
19
08
2024
revised:
10
09
2024
accepted:
28
10
2024
medline:
29
10
2024
pubmed:
29
10
2024
entrez:
29
10
2024
Statut:
aheadofprint
Résumé
The use of ultrasound (US)-guided venous puncture for cardiac pacing/defibrillation lead placement may minimize the risk of peri-procedural complications and radiation exposure. However, none of the published studies have been sufficiently powered to recommend this approach as the standard of care. We compare the safety and efficacy of ultrasound-guided axillary venous puncture (US-AVP) versus fluoroscopy-guided access for cardiac implantable electronic devices (CIED) by performing an individual patient data meta-analysis based on previously published studies. We conducted a thorough literature search encompassing longitudinal investigations (five randomized and one prospective studies) reporting data on Xray-guided and US-AVP for CIED procedures. The primary endpoint was to compare the safety of the two techniques. Secondary endpoints included the success rate of each technique, the necessity of switching to alternative methods, the time needed to obtain venous access, Xray exposure and the occurrence of peri-procedural complications. Six longitudinal eligible studies were identified including 700 patients (mean age 74.9 ±12.1 years, 68.4% males). The two approaches for venous cannulation showed a similar success rate. The use of a Xray guided approach significantly increased the risk of inadvertent arterial punctures (OR: 2.15, 95% CI: 2.10-2.21, p=0.003), after adjustment for potential confounders. Conversely, an US-AVP approach reduces time to vascular access, radiation exposure and the number of attempts to vascular access. The US-AVP enhances safety by reducing radiation exposure and time to vascular access while maintaining a low rate of major complications compared to the x-ray-guided approach.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
The use of ultrasound (US)-guided venous puncture for cardiac pacing/defibrillation lead placement may minimize the risk of peri-procedural complications and radiation exposure. However, none of the published studies have been sufficiently powered to recommend this approach as the standard of care. We compare the safety and efficacy of ultrasound-guided axillary venous puncture (US-AVP) versus fluoroscopy-guided access for cardiac implantable electronic devices (CIED) by performing an individual patient data meta-analysis based on previously published studies.
METHODS
METHODS
We conducted a thorough literature search encompassing longitudinal investigations (five randomized and one prospective studies) reporting data on Xray-guided and US-AVP for CIED procedures. The primary endpoint was to compare the safety of the two techniques. Secondary endpoints included the success rate of each technique, the necessity of switching to alternative methods, the time needed to obtain venous access, Xray exposure and the occurrence of peri-procedural complications.
RESULTS
RESULTS
Six longitudinal eligible studies were identified including 700 patients (mean age 74.9 ±12.1 years, 68.4% males). The two approaches for venous cannulation showed a similar success rate. The use of a Xray guided approach significantly increased the risk of inadvertent arterial punctures (OR: 2.15, 95% CI: 2.10-2.21, p=0.003), after adjustment for potential confounders. Conversely, an US-AVP approach reduces time to vascular access, radiation exposure and the number of attempts to vascular access.
CONCLUSIONS
CONCLUSIONS
The US-AVP enhances safety by reducing radiation exposure and time to vascular access while maintaining a low rate of major complications compared to the x-ray-guided approach.
Identifiants
pubmed: 39471341
pii: 7848895
doi: 10.1093/europace/euae274
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.