Cephalic vein cutdown (CVC) and axillary vein puncture (AVP) are effective approaches for cardiac implantable electronic device (CIED) implantation and may offer a lower risk of complications, compared with subclavian vein puncture (SVP), according to results of a study presented during ACC.20/WCC and simultaneously published in JACC: Clinical Electrophysiology.

Varunsiri Atti, MD, et al., reviewed 23 studies comparing SVP, AVP and CVC to evaluate the efficacy and safety of venous access techniques for CIED implantation. All studies with individuals age 18 and older with at least one month of follow-up that evaluated the efficacy and safety of SVP/AVP with CVC and reported at least one clinical outcome of interest were included. The primary outcomes of interest were complications (pneumothorax, device/lead failure, pocket hematoma/bleeding and device infection), acute procedural success, and total procedure time. The researchers then conducted a meta-analysis using a random effects model to calculate risk ratios and mean differences.

The 23 studies included 35,722 patients (SVP, 18,009 patients; AVP, 409 patients; and CVC, 17,304 patients). Compared with CVC, SVP was associated with a higher risk of pneumothorax (risk ratio [RR], 4.88; 95% confidence interval [CI], 2.95 to 8.06) and device/lead failure (RR, 2.09; 95% CI, 1.07 to 4.09). No significant difference were seen in these outcomes compared with AVP. In addition, acute procedural success was significantly higher with SVP compared with CVC (RR, 1.24; 95% CI, 1.00 to 1.53). No significant differences were seen in complications such as pocket/hematoma, device infection or pericardial effusion between SVP or AVP compared with CVC.

According to the researchers, CVC is associated with a lower risk of pneumothorax and lead failure than SVP. CVC or AVP are "both effective approaches for CIED lead implantation and have the potential to avoid complications usually observed with traditional SVP," they conclude.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Pericardial Disease

Keywords: ACC Annual Scientific Session, acc20, Axillary Vein, Subclavian Vein, Pneumothorax, Pericardial Effusion, Venous Cutdown, Hematoma, Punctures, Hemorrhage, Infections

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