Arrhythmias & electrophysiologyRandomised controlled trial
Intra-pocket ultrasound-guided axillary vein puncture vs. cephalic vein cutdown for cardiac electronic device implantation: the ACCESS trial
- Randomised controlled trial
- investigator-led
- monocentric
- superiority
- 1:1
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
Primary result
As reported in the abstract
P = 0.001
Secondary outcomes
Time to venous access
GMR 0.32 (0.28–0.36) · P < 0.001
Total procedure duration
GMR 0.72 (0.67–0.78) · P < 0.001
Fluoroscopy time
GMR 0.74 (0.63–0.86) · P < 0.001
X-ray exposure
GMR 0.76 (0.62–0.93) · P = 0.009
| Outcome | IPUS-AVP | CVC | Estimate | P value |
|---|---|---|---|---|
| Success with CVC followed by subclavian vein puncture | Not reported in the abstract | 96.0% | P = 0.21 |
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:10.1093/eurheartj/ehad629
Summarised from the published abstract; every number is checked against it