Arrhythmias & electrophysiology
Intra-pocket ultrasound-guided axillary vein puncture vs. cephalic vein cutdown for cardiac electronic device implantation: the ACCESS trial
Authors' conclusion
IPUS-AVP is superior to CVC in terms of success rate, time to venous access, procedure duration, and radiation exposure. Complication rates were similar between the two groups.
Study context
- Population
- Patients undergoing transvenous cardiac implantable electronic devices (CIED) implantation
- Participants
- 200 patients
- Comparison
- IPUS-AVP vs cephalic vein cutdown (CVC) for venous access in CIED implantation
- IPUS-AVPn = 101
- CVCn = 99reference
- Primary endpoint
- Success rate of insertion of all leads using the first assigned venous access technique
Methodological detailsinvestigator-led, monocentric, superiority, 1:1
- Investigator-led
- Monocentric
- Superiority
- 1:1
Primary result
As reported in the abstract
P = 0.001
Secondary outcomes
| Outcome | IPUS-AVP | CVC | GMR (95% CI) | P value | |
|---|---|---|---|---|---|
| Time to venous access | 3.4 min | 10.6 min | 0.32 (0.28–0.36) | P < 0.001 | |
| Total procedure duration | 33.8 min | 46.9 min | 0.72 (0.67–0.78) | P < 0.001 | |
| Fluoroscopy time | 2.4 min | 3.3 min | 0.74 (0.63–0.86) | P < 0.001 | |
| X-ray exposure | 1083 mGy.cm² | 1423 mGy.cm² | 0.76 (0.62–0.93) | P = 0.009 | |
| 0.20.5125Geometric mean ratio (log scale) |
| Outcome | IPUS-AVP | CVC | P value |
|---|---|---|---|
| Success with CVC followed by subclavian vein puncture | — not stated in the abstract | 96.0% | P = 0.21 |
— not stated in the abstract
Safety
Complications · 3 months
- No significant difference in complication rates between groups
- P = 0.68
Original publication
Intra-pocket ultrasound-guided axillary vein puncture vs. cephalic vein cutdown for cardiac electronic device implantation: the ACCESS trial. Eur Heart J. Published 13 October 2023. doi:10.
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