Axillary vein access for antiarrhythmic cardiac device implantation: a literature review

Abstract

The current narrative review provides an update of available knowledge on venous access techniques for cardiac implantable electronic device implantation, with a focus on axillary vein puncture. Lower procedure-related and lead-related complications have been reported with extrathoracic vein puncture techniques compared with intrathoracic accesses. In particular, extrathoracic lead access through the axillary vein seems to be associated with lower complication incidence than subclavian vein puncture and higher success rate than cephalic vein cutdown. In literature, many techniques have been described for axillary vein access. The use of contrast venography-guided puncture has facilitated the diffusion of the axillary vein approach for device implantation. Venography may be particularly useful in specific demographic and clinical device implantation contexts. Ultrasound-guided or microwire-guided vascular access for lead positioning can be considered a valid alternative to venography, although current applications for axillary vein puncture need further evaluations.

Feasibility of Ultrasound-Guided Axillary Vein Puncture under Valsalva Maneuver for Diagnostic and Cardiovascular Interventional Purposes: Pacemaker and Cardioverter-Defibrillator Implantation

“…Nonetheless, its anatomical characteristics (i.e., thinness and tortuosity) lower the success rate of cannulation, especially when managing the placement of multiple leads [14][15][16]. In the last decade, the puncture of the infraclavicular axillary vein (AV) has been emerging as an alternative technique for CIED leads insertion [17,18]. This venous approach is characterized by a higher success rate and greater safety as compared to cephalic vein cutdown and subclavian vein puncture, respectively [19][20][21].…”

Handheld ultrasound device-guided axillary vein access for pacemaker and defibrillator implantation

“…3,4 Over the last years, the AV puncture has been proven to be an alternative approach, both safer and more successful than subclavian vein and cephalic vein, respectively. 5,6 Several techniques for approaching AV during transvenous CIED implantation have been reported. Initially, the venous puncture was performed based on surface anatomic landmarks (blind approach) or guided by fluoroscopy landmarks or contrast venography.…”

The Use of a Handheld Ultrasound Device to Guide the Axillary Vein Access during Pacemaker and Cardioverter-Defibrillator Implantation. A Feasibility Study

“…Over the last years, axillary vein (AV) access has provided an alternative technique safer and more successful than the subclavian vein and cephalic vein, respectively [ 2 , 6 ]. The standard approach to the AV is performed by an extrathoracic venipuncture under fluoroscopy guidance, with or without contrast venography [ 7 ].…”