FLUOROSCOPY GUIDED AXILLARY VENEPUNCTURE FOR CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE IMPLANTATION: A RANDOMIZED COMPARISION OF NON-CONTRAST TECHNIQUES

Résumé

Purpose: This study was conducted to compare the safety and efficacy of the microwire assisted technique with the conventional fluoroscopic and caudal fluoroscopic guided axillary venipuncture for lead delivery in patients undergoing cardiovascular implantable electronic device (CIED) implantation

Study Design: Prospective randomized study

Materials and Methods: This study included 286 consecutive adult patients undergoing CIED implantation at our institute between 2017 and 2019. Patients were randomized into three groups, conventional fluoroscopy guided and caudal fluoroscopy guided axillary venipuncture formed groups I (Group I ; n=97) and II (Group II; n=94) respectively and microwire assisted technique formed Group III (n=95) .

Outcome measures including technical success rate, number of attempts to successful puncture, puncture duration, fluoroscopy time, adverse events were compared among the three groups.

Results: We demonstrated significantly higher overall success rate, higher first attempt success rates, shorter puncture durations and fluoroscopy times and lesser number of attempts to successful puncture with microwire assisted technique;Group III (100%, 91.6%, 39.3 ±26.7, 67.1±31.8, 1.31±0.9) as compared to conventional;Group I ((82%, 56.7%, 87.6 ±37.3, 168±54.6, 2.7±1.3) and Caudal ;Group II (84%, 58.5%, 85.9 ±42.6, 160±58.2, 2.5±1.4) respectively with p value <0.001. Adverse events were significantly lower in group III.

Conclusion: Microwire assisted technique is a simple, quicker, safer and more efficacious among non-contrast based axillary venipuncture techniques for CIED implantation.

Implications: Microwire assisted technique may be particularly useful in patients with contrast allergy, renal or advanced heart failure. The small added cost to the patients may be justified given the advantage that this technique offers.