Ultrasound-Guided Axillary Vein Puncture for Cardiac Device Implantation: A Systematic Review and Meta-Analysis

Ultrasound-guided axillary vein puncture (US-AVP) has recently emerged as a valid alternative to standard vein puncture (SVP) for cardiac implantable electronic device implantation. This meta-analysis aimed to compare the efficacy and safety of US-AVP versus SVP. A comprehensive search of PubMed, Embase, and Cochrane databases identified randomized clinical trials and nonrandomized clinical trials comparing these techniques. Pooled relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models, and trial sequential analysis was conducted to assess the robustness of findings. Twelve studies met the inclusion criteria, including 3085 patients (1227 in the US-AVP group and 1858 in the SVP group). US-AVP significantly reduced total complication rates compared with SVP [RR, 0.65 (95% CI, 0.48-0.89); P = 0.006; I² = 0%], with no significant difference in success rates [RR, 1.05 (95% CI, 0.99-1.11); P = 0.137; I² = 60%]. Fluoroscopy duration was significantly shorter in the US-AVP group [MD, -1.58 min (95% CI, -2.16 to -0.99); P < 0.001; I² = 81%], and X-ray exposure was markedly lower [MD, -3.23 mGy·cm² (95% CI, -6.03 to -0.43); P = 0.024; I² = 93%]. The trial sequential analysis supported the robustness of the evidence for reduced complications. In conclusion, US-AVP demonstrated a safety advantage over SVP by reducing complications while achieving comparable efficacy.