Skip to main content
SpringerLink
Log in

Body mass index is related to unsuccessful puncture attempts and failure to axillary vein cannulation during ultrasound-guided cardiac electronic device implantation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Ultrasound (US)-guided axillary vein cannulation is effective and safe during cardiac implantable electronic devices (CIEDs). It is a reasonable alternative to other techniques in order to shorten procedural time and decrease perioperative complications. However, in this context, the short-axis (out-of-plane) visualization to guide the vein puncture is the most used technique. The aim of our study is to describe a single-center experience with the US long-axis (in-plane) technique defining predictors of unsuccessful puncture attempts and failure to axillary vein cannulation in a cohort of patients undergoing CIEDs procedures.

Methods

From November 2017 to June 2019, consecutive patients undergoing CIEDs procedures were enrolled in the study. US-guided long axis (in-plane) view to guide axillary vein cannulation was used in all subjects. Unsuccessful puncture attempts (UAs) and complete failures to cannulate the vein were collected for each procedure. All patients were evaluated on a daily basis until hospital discharge and at 1-month follow up visit.

Results

Among 119 subjects (M: F = 75:44), mean age was 79 ± 9 years, mean BMI 25.7 ± 4.3 kg/m2, and mean BSA 1.74 ± 0.4 m2. We placed 95 pacemakers (32 single-, 61 dual-, and 2 triple-chamber) and 20 ICDs (7 single, 6 dual, 7 triple chambers). An upgrade from dual-chamber to triple-chamber device was carried out with the addition of a new lead in 3 patients. During a system revision, one new electrode was implanted. The overall leads inserted were 204. There were 33 initial unsuccessful attempts in 22/119 patients. US-guided axillary access was finally successful in 94.9% of patients (113/119). In the other cases (6/119), cephalic vein was isolated or blinded subclavian puncture was performed. Interestingly, at univariate analysis, an increasing BMI and BSA, male sex, and anticoagulant therapy were predictors of unsuccessful attempts or failure to cannulate the vein with US. Among those subjects, the multivariate logistic regression showed significant correlations only between BMI and unsuccessful attempts: odds ratio (OR) = 1.16, p = 0.009 [95% CI = 1.04–1.31], and BMI with failure to cannulate the vein: OR = 1.21, p = 0.03 [95%CI = 1.01–1.45]. The receiver operating characteristic (ROC) curves individuated the best BMI value cutoff point at 27 kg/m2 (area under the curve [AUC]: 68.6%) having a sensitivity of 63.6% and a specificity of 66.5% for unsuccessful puncture attempts; a BMI value of 28 kg/m2 (AUC 74.9%) had a sensitivity of 66.7% and a specificity of 66.7% for failure to cannulate the vein with the US-guided approach.

Conclusions

Axillary vein long-axis (in-plane) US-guided cannulation during CIEDs implantation is characterized by a high success rate (94.9%). An elevated BMI is significantly related to unsuccessful puncture attempts or failure to cannulation. The higher is the BMI, the more are the chances to have difficult vein puncture or cannulation failure and to switch from US-guided approach to another technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The corresponding author keeps all the material relating to each patient included in the study. This material is available for evaluation at Editors discretion.

References

  1. Greenspon AJ, Patel JD, Lau E, Ochoa JA, Ho RT, Pavri BB, et al. Trends in permanent pacemaker implantation in the United States from 1993 to 2009 increasing complexity of patients and procedures. J Am Coll Cardiol. 2012;60:1540–5.

    Article  Google Scholar 

  2. Bongiorni MG, Proclemer A, Dobreanu D, Marinskis G, Pison L, Blomstrom-Lundqvist C. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European heart rhythm association survey. Europace. 2013;15:1664–8.

    Article  Google Scholar 

  3. Sharma G, Senguttuvan NB, Thachil A, Leong D, Naik N, Yadav R, et al. A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion. Can J Cardiol. 2012;28:542–6.

    Article  Google Scholar 

  4. Seto AH, Jolly A, Salcedo J. Ultrasound-guided venous access for pacemakers and defibrillators. J Cardiovasc Electrophysiol. 2013;24:370–4.

    Article  Google Scholar 

  5. Antonelli D, Feldman A, Freedberg NA, Turgeman Y. Axillary vein puncture without contrast venography. Pacing Clin Electrophysiol. 2013;36:1107–10.

    Article  Google Scholar 

  6. Migliore F, Siciliano M, De Lazzari M, Ferretto S, Dalla Valle C, Zorzi A, et al. Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads. J Interv Card Electrophysiol. 2015;43:263–7.

    Article  Google Scholar 

  7. Chan NY, Kwong NP, Cheong AP. Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown. Europace. 2017;19:1193–7.

    Article  Google Scholar 

  8. Esmaiel A, Hassan J, Blenkhorn F, Mardigyan V. The use of ultrasound to improve axillary vein access and minimize complications during pacemaker implantation. Pacing Clin Electrophysiol. 2016;39:478–82.

    Article  Google Scholar 

  9. Franco E, Rodriguez Munoz D, Matia R, Hernandez-Madrid A, Carbonell San Roman A, Sanchez I, et al. Wireless ultrasound-guided axillary vein cannulation for the implantation of cardiovascular implantable electric devices. J Cardiovasc Electrophysiol. 2016;27:482–7.

    Article  Google Scholar 

  10. Liccardo M, Nocerino P, Salzano G, Ciardiello C. Efficacy of ultrasound-guided axillary/subclavian venous approaches for pacemaker and defibrillator lead implantation: a randomized study. J Interv Card Electrophysiol. 2018;51:153–60.

    Article  Google Scholar 

  11. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoaugulants in patients with atrial fibrillation. Eur Heart Journal. 2018;39:1330–93.

    Article  CAS  Google Scholar 

  12. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 2015;1:CD011447.

    PubMed  Google Scholar 

  13. De Sensi F, Miracapillo G, Addonisio L, Breschi M, Paneni F, Cresti A, et al. Axillary vein access with or 5 without venography: is this the dilemma in the ultrasounds era? Europace. 2018;20:1389–90.

    Article  Google Scholar 

  14. Bozyel S, Yalniz A, Aksu T, Guler TE, Genez S. Ultrasound-guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices. Pacing Clin Electrophysiol. 2019;42:1026–31.

    Article  Google Scholar 

  15. Lin J, Adsit G, Barnett A, Tattersall M, Field ME, Wright J. Feasibility of ultrasound-guided vascular access during cardiac implantable device placement. J Interv Card Electrophysiol. 2017;50:105–9.

    Article  Google Scholar 

  16. Sommerkamp SK, Romaniuk VM, Witting MD, Ford DR, Allison MG, Euerle BD. A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation. Am J Emerg Med. 2013;3:478–81.

    Article  Google Scholar 

  17. Stone MB, Moon C, Sutijono D, Blaivas M. Needle tip visualization during ultrasound-guided vascular access: short axis vs long axis approach. Am J Emerg Med. 2010;28:343–7.

    Article  Google Scholar 

  18. Ahmed AS, Gilge JL, Clark BA, Shah A, Bagga S, Padanilam MS, et al. Predictors of successful ultrasound guided lead implantation. Pacing Clin Electrophysiol. 2020;43:217–22.

    Article  Google Scholar 

  19. Kim IS, Kang SS, Park JH, Hong SJ, Shin KM, Yoon YJ, et al. Impact of sex, age and BMI on depth and diameter of the infraclavicular axillary vein when measured by ultrasonography. Eur J Anaesthesiol. 2011;28:346–50.

    Article  Google Scholar 

  20. Chen JY, Chang KC, Lin YC, Chou HT, Hung JS. Pre-procedure duplex ultrasonography to assist cephalic vein isolation in pacemaker and defibrillator implantation. J Interv Card Electrophysiol. 2005;12:75–81.

    Article  CAS  Google Scholar 

  21. Szabo TL, Lewin PA. Ultrasound transducer selection in clinical imaging practice. J Ultrasound Med. 2013;32:573–82.

    Article  Google Scholar 

  22. Abboud PC, Kendall JL. Ultrasound guidance for vascular access. Emerg Med Clin North Am. 2004;22:749–73.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Electrophysiology Unit, Cardiology Department, ESTAV Toscana Sud Est, Misericordia Hospital, Via Senese 161, 58100, Grosseto, Italy

    Francesco De Sensi, Luigi Addonisio, Pasquale Baratta, Marco Breschi, Alberto Cresti, Gennaro Miracapillo & Ugo Limbruno

Authors
  1. Francesco De Sensi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luigi Addonisio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pasquale Baratta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Breschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alberto Cresti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gennaro Miracapillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ugo Limbruno
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Each author has contributed significantly to the present work.

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Francesco De Sensi and Luigi Addonisio and Marco Breschi and Gennaro Miracapillo. The first draft of the manuscript was written by Francesco De Sensi and Alberto Cresti and Pasquale Baratta and Ugo Limbruno. All the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Francesco De Sensi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. All the procedures being performed were part of the routine clinical care. The study was conducted according to the 1964 Declaration of Helsinki and authors are complying with the specific requirements of their institution and their countries.

Consent to participate/consent of publication

Informed consent was obtained from each patient.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Sensi, F., Addonisio, L., Baratta, P. et al. Body mass index is related to unsuccessful puncture attempts and failure to axillary vein cannulation during ultrasound-guided cardiac electronic device implantation. J Interv Card Electrophysiol 61, 253–259 (2021). https://doi.org/10.1007/s10840-020-00800-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-020-00800-3

Keywords

Search

Navigation