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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.
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]
Copyright of Pacing & Clinical Electrophysiology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: 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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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Courtney%2C+Alex+M%2E%22&quot;&gt;Courtney, Alex M.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Chandler%2C+Jonathan+K%2E%22&quot;&gt;Chandler, Jonathan K.&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Anderson%2C+John%22&quot;&gt;Anderson, John&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Shrestha%2C+Amit%22&quot;&gt;Shrestha, Amit&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Noheria%2C+Amit%22&quot;&gt;Noheria, Amit&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Pimentel%2C+Rhea%22&quot;&gt;Pimentel, Rhea&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Dendi%2C+Raghuveer%22&quot;&gt;Dendi, Raghuveer&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ramirez%2C+Rigoberto%22&quot;&gt;Ramirez, Rigoberto&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Reddy%2C+Y%2E+Madhu%22&quot;&gt;Reddy, Y. Madhu&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sheldon%2C+Seth+H%2E%22&quot;&gt;Sheldon, Seth H.&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;i&gt; ssheldon@kumc.edu&lt;/i&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Pacing+%26+Clinical+Electrophysiology%22&quot;&gt;Pacing &amp; Clinical Electrophysiology&lt;/searchLink&gt;. Dec2022, Vol. 45 Issue 12, p1364-1371. 8p.
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: 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 &#177; 14 years, BMI 27 &#177; 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 &lt;.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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  Data: &lt;i&gt;Copyright of Pacing &amp; Clinical Electrophysiology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1111/pace.14611
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        Text: English
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      – SubjectFull: Learning assessment
        Type: general
      – SubjectFull: Subclavian veins
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      – SubjectFull: Ultrasonic imaging
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      – SubjectFull: Implantable cardioverter-defibrillators
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      – SubjectFull: Surgical complications
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      – SubjectFull: Brachiocephalic veins
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      – SubjectFull: Axillary vein
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              Text: Dec2022
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