The researchers compared the “in-pocket” approach through the axillary vein with the traditional technique of lateral saphenous vein venesection performed during implantable electronic cardiovascular devices. The effectiveness of access through the axillary vein was superior to venesection of the lateral saphenous vein in several respects.
Scientists from the Croix-Rousse Hospital and the South Lyon Hospital compared the effectiveness of ultrasound-guided “in-pocket” axillary venous access for the placement of implantable electronic cardiovascular devices with traditional lateral vein access. The study results were published in the European Heart Journal.
The “in-pocket” technique of access through the axillary vein demonstrated a significant advantage in both the primary endpoint (procedural success of all electrodes) and secondary endpoints. The success rate of access through the axillary vein was 99%, and the success rate of access through the lateral saphenous vein was 86.9%. Venous access time was 3.4 minutes. in the study group compared to 10.6 min. with traditional access. The total time of the entire procedure was 33.8 minutes. and 46.9 min. respectively. The duration of fluoroscopy was 2.4 minutes. and 3.3 min. respectively. Radiation load reached 1083 mGy/cm2 compared to 1423 mGy/cm². There were no differences in the incidence of complications between groups.
The interventional study included 200 patients aged 18 years and older with indications for installation of a permanent transvenous pacemaker or cardioverter-defibrillator (single-chamber or dual-chamber device), who were stratified depending on the number of implanted electrodes (single- or dual-chamber device). The “intrapocket” approach technique involved creating a subcutaneous pocket for the generator, which was performed under local anesthesia after an incision 1 cm medial to the deltopectoral groove and dissection of the subcutaneous tissue to the pectoral muscle.