U ltra S ound A xillary Vein A ccess (USAA): Learning curve and randomized comparison to traditional venous access for cardiac device implantation.
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| Title: | U ltra S ound A xillary Vein A ccess (USAA): Learning curve and randomized comparison to traditional venous access for cardiac device implantation. |
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| Authors: | Courtney, Alex M.1, Chandler, Jonathan K.2, Anderson, John3, Shrestha, Amit3, Noheria, Amit3, Pimentel, Rhea3, Dendi, Raghuveer3, Ramirez, Rigoberto3, Reddy, Y. Madhu3, Sheldon, Seth H.3 ssheldon@kumc.edu |
| Source: | Pacing & Clinical Electrophysiology. Dec2022, Vol. 45 Issue 12, p1364-1371. 8p. |
| Subjects: | Learning assessment, Subclavian veins, Ultrasonic imaging, Implantable cardioverter-defibrillators, Surgical complications, Brachiocephalic veins, Axillary vein, Treatment effectiveness, Randomized controlled trials, Descriptive statistics, Cardiac pacemakers, Statistical sampling, Longitudinal method |
| Abstract: | Background: Many techniques exist for venous access (VA) during cardiac implantable electronic device (CIED) implantation. Objective: We sought to evaluate the learning curve with ultrasound (US) guided axillary vein access (USAA). Methods: Single‐center prospective randomized controlled trial of patients undergoing CIED implantation. Patients were randomized in a 2:1 fashion to USAA versus conventional VA techniques. The primary outcomes were the success rates, VA times and 30‐day complication rates. Results: The study included 100 patients (age 68 ± 14 years, BMI 27 ± 4 kg/m2). USAA was successful in 66/70 implants (94%). Initial attempts at conventional VA included 47% axillary (n = 14), 30% (n = 9) cephalic, and 23% (n = 7) subclavian. The median access time was longer for USAA than conventional access (8.3 IQR 4.2–15.3 min vs. 5.2 IQR 3.4–8.6 min, p =.009). Among the five inexperienced USAA implanters, there was a significant improvement in median access time from first to last tertile of USAA implants (17.0 IQR 7.0–21.0 min to 8.6 IQR 4.5–10.8 min, p =.038). The experienced USAA implanter had similar access times with USAA compared with conventional access (4.0 IQR 3.3–4.7 min vs. 5.2 IQR 3.4–8.6 min, p =.15). Venograms were less common with USAA than conventional access (2% vs. 33%, p <.0001). The 30‐day complication rate was similar with USAA (n = 4/70, 6%) versus conventional (n = 3/30, 10%, p =.44). Conclusion: Although the success rate with USAA was high, there was a significant learning curve. Once experienced with the USAA technique, there is the potential for reduced complications without adding to the procedure duration. [ABSTRACT FROM AUTHOR] |
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| Database: | Engineering Source |
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| Abstract: | Background: Many techniques exist for venous access (VA) during cardiac implantable electronic device (CIED) implantation. Objective: We sought to evaluate the learning curve with ultrasound (US) guided axillary vein access (USAA). Methods: Single‐center prospective randomized controlled trial of patients undergoing CIED implantation. Patients were randomized in a 2:1 fashion to USAA versus conventional VA techniques. The primary outcomes were the success rates, VA times and 30‐day complication rates. Results: The study included 100 patients (age 68 ± 14 years, BMI 27 ± 4 kg/m2). USAA was successful in 66/70 implants (94%). Initial attempts at conventional VA included 47% axillary (n = 14), 30% (n = 9) cephalic, and 23% (n = 7) subclavian. The median access time was longer for USAA than conventional access (8.3 IQR 4.2–15.3 min vs. 5.2 IQR 3.4–8.6 min, p =.009). Among the five inexperienced USAA implanters, there was a significant improvement in median access time from first to last tertile of USAA implants (17.0 IQR 7.0–21.0 min to 8.6 IQR 4.5–10.8 min, p =.038). The experienced USAA implanter had similar access times with USAA compared with conventional access (4.0 IQR 3.3–4.7 min vs. 5.2 IQR 3.4–8.6 min, p =.15). Venograms were less common with USAA than conventional access (2% vs. 33%, p <.0001). The 30‐day complication rate was similar with USAA (n = 4/70, 6%) versus conventional (n = 3/30, 10%, p =.44). Conclusion: Although the success rate with USAA was high, there was a significant learning curve. Once experienced with the USAA technique, there is the potential for reduced complications without adding to the procedure duration. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 01478389 |
| DOI: | 10.1111/pace.14611 |
