Efficacy of ultrasound-guided axillary/subclavian venous approaches for pacemaker and defibrillator lead implantation: a randomized study

Subclavian access is a reliable technique for lead insertion in pacemaker and defibrillator (ICD) implantation, but it is often accompanied by complications. The aim of this study was to compare the efficacy of the ultrasound-guided axillary approach to the subclavian method. This randomized comparative study was performed on 174 patients: as a first attempt, 116 patients underwent the ultrasound-guided axillary access and 58 patients underwent the subclavian approach. A total of 364 leads were placed. Operators were trained in ultrasound-guided vein access technique. Axillary access was successful in 69% of patients (32/46), in the training phase and, as a first attempt, in 91.4% of patients (106/116), in the randomized phase. When axillary approach failed, we performed the following: subclavian access in 5.2% of patients (6/116), cephalic approach in 2.6% of patients (3/116), surgical method in 0.9% of patients (1/116). The subclavian technique was effective, as a first attempt, in 55 patients (94.8%). When the subclavian access failed, the ultrasound axillary approach successfully performed in all three cases. During a mean follow-up of 18 +/- 6 months, the number of lead complications was similar in the subclavian group compared to the axillary group (p = 0.664). As first attempt, ultrasound-guided axillary method showed similarly high-success rate than subclavian approach and well performed when the first attempt in subclavian group failed. Axillary access can be considered a safe and effective alternative technique to the conventional subclavian method for device implantation.