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Real-time venography-guided extrathoracic puncture technique for cardiovascular implantable electronic device implantation

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Abstract

Central venous access is an essential technique for cardiovascular implantable electronic device (CIED) implantation, and the use of axillary vein approach has recently been increasing. This study sought to examine whether real-time venography-guided extrathoracic puncture facilitates the procedure. We retrospectively analyzed 179 consecutive patients who underwent CIED implantation using the axillary vein puncture method. Patients were divided into two groups: the conventional method group (CG, n = 107) and the real-time venography-guided group (RG, n = 82). The application of real-time venography was at the discretion of individual operators. Operators with experience of less than 50 CIED implantations were defined as inexperienced operators in this study. Puncture duration and number of attempts were significantly less in the RG group than in the CG group (283 ± 198 vs. 421 ± 361 s, p < 0.01, and 3.19 ± 2.00 vs. 4.18 ± 2.85, p < 0.01). These benefits of real-time venography were observed in inexperienced operators, but not in experienced operators. In addition, the success rate without extra attempts at puncture was higher in the RG group (54% vs. 32%, p < 0.01). Although the total amount of contrast medium was higher in the RG group (16.3 ± 4.1 mL vs. 11.9 ± 6.6 mL, p < 0.01), serum levels of creatinine pre- and post-operation were not different in the two groups (p = NS). We concluded that real-time venography is a safe and effective method for axillary vein puncture, especially in inexperienced operators.

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Funding

This work was supported in part by JSPS KAKENHI Grant Numbers 17K16021 and 20K08406.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan

    Manabu Kashiwagi, Akio Kuroi, Kosei Terada, Takashi Tanimoto, Teruaki Wada, Kunihiro Shimamura, Yasutsugu Shiono, Takashi Kubo, Atsushi Tanaka & Takashi Akasaka

  2. Department of Cardiovascular Medicine, Shingu Municipal Medical Center, Wakayama, Japan

    Yosuke Katayama & Akira Taruya

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  1. Manabu Kashiwagi
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  2. Yosuke Katayama
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  3. Akio Kuroi
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  4. Akira Taruya
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  5. Kosei Terada
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  6. Takashi Tanimoto
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  7. Teruaki Wada
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  8. Kunihiro Shimamura
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  9. Yasutsugu Shiono
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  10. Takashi Kubo
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  11. Atsushi Tanaka
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  12. Takashi Akasaka
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Correspondence to Manabu Kashiwagi.

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Kashiwagi, M., Katayama, Y., Kuroi, A. et al. Real-time venography-guided extrathoracic puncture technique for cardiovascular implantable electronic device implantation. Heart Vessels 37, 91–98 (2022). https://doi.org/10.1007/s00380-021-01885-0

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  • DOI: https://doi.org/10.1007/s00380-021-01885-0

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