Axillary Versus Subclavian Venous Access for Permanent Pacemaker Implantation: Complications, Evolving Techniques and...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Venous access is critical for permanent pacemaker implantation, impacting safety and device longevity.
• The subclavian vein, traditionally used, carries risks like pneumothorax and hemothorax.
• Axillary vein access is emerging as a potentially safer alternative, with studies suggesting fewer complications.

Purpose of the Study:

• To review complication patterns associated with different venous access sites for pacemaker implantation.
• To compare the safety and efficacy of axillary versus subclavian venous access.
• To inform individualized, evidence-based venous access selection in contemporary pacemaker procedures.

Main Methods:

• Systematic review and appraisal of existing observational studies and randomized trials.
• Analysis of complication rates, including pneumothorax, hemothorax, and arterial puncture.
• Evaluation of factors influencing outcomes, such as ultrasound guidance and operator experience.

Main Results:

• Axillary access, particularly with ultrasound, shows potential for reduced pneumothorax and arterial puncture rates.
• Evidence quality for axillary access benefits is moderate due to study heterogeneity.
• Advances like routine ultrasound guidance enhance procedural safety and consistency.

Conclusions:

• Venous access selection for pacemaker implantation requires careful consideration of anatomical and patient-specific factors.
• Axillary access may be preferable to subclavian access in many cases, especially when utilizing advanced techniques.
• Individualized, evidence-aligned selection optimizes procedural outcomes and long-term device performance.