Ultrasound (short-axis out of plane) axillary vein access during CIED implantation and fluoroscopy exposition

Abstract Background Axillary vein access for CIED implantation is suggested by the guidelines as a safer approach. Ultrasound (US) guided axillary access may reduce the fluoroscopic (FL) exposition time as an alternative to other axillary accesses. We sought to compare FL times in a large cohort of patients. Methods From October 2021 to October 2024, 719 consecutive patients (mean age 79.6 +/- 11 y; 466 male) underwent CIED implantation by using an axillary access during the following CIED procedures: PMDR 398 (55.3%); PMVR 154 (21.4%); CRTP 10 (1.4%) CRTD 51 (7%) ICD 93 (13 %) CIED lead revision 13 (1.8%). Patients with a subclavian or cephalic approaches were excluded. Among them, 395/719 patients (55%, 265 male) underwent to US guided approach (US group), while 324/719 (45 %; 201 male) to FL guided approach (FL group). Results The US group patients were younger as compared with the FL group (78 +/- 11 vs 81.5+/- 10.7, p=<0.001). The median values of FL expositions in the US group and in the FL were 135 vs 224 sec; respectively (Shapiro Wilk W < 0.001; Mann Whitney p < 0.01). Conclusion An US guided axillary access may reduce the FL exposition as compared to a FL guided access.