{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T07:09:04Z","timestamp":1782544144847,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,1,2]],"date-time":"2021-01-02T00:00:00Z","timestamp":1609545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Ultrasound guided axillary vein access (UGAVA) is an emerging approach for cardiac implantable electronic device (CIED) implantation not widely utilized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>This is a retrospective, age and sex\u2010matched cohort study of CIED implantation from January 2017 to July 2019 comparing UGAVA before incision to venous access obtained after incision without ultrasound (conventional).<\/jats:p><jats:p>The study population included 561 patients (187 with attempted UGAVA, 68\u2009\u00b1\u200913 years old, 43% women, body mass index (BMI) 30\u2009\u00b1\u20098\u2009kg\/m<jats:sup>2<\/jats:sup>, 15% right\u2010sided, 43% implantable cardioverter\u2010defibrillator, 15% upgrades). UGAVA was successful in 178\/187 patients (95%). In nine patients where UGAVA was abandoned, the vein was too deep for access before incision. BMI was higher in abandoned patients than successful UGAVA (38\u2009\u00b1\u20096 vs. 28\u2009\u00b1\u20096\u2009kg\/m<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). Median time from local anesthetic to completion of UGAVA was 7\u2009min (interquartile range [IQR]: 4\u201310) and median procedure time 61\u2009min (IQR: 50\u201392). UGAVA changed implant laterality in two patients (avoiding an extra incision in both) and could have prevented unnecessary incision in four conventional patients. Excluding device upgrades, there was reduced fluoroscopy time in UGAVA versus conventional (4 vs. 6\u2009min; IQR: 2\u20135 vs. 4\u20139; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Thirty\u2010day complications were similar in UGAVA versus conventional (<jats:italic>n<\/jats:italic>\u2009=\u20097 vs. 26, 4 vs. 7%; <jats:italic>p<\/jats:italic>\u2009=\u2009.13, <jats:italic>p<\/jats:italic>\u2009=\u2009.41 adjusting for upgrades), partly driven by a trend towards reduced pneumothorax (<jats:italic>n<\/jats:italic>\u2009=\u20090 vs. 3, 0 vs. 1%; <jats:italic>p<\/jats:italic>\u2009=\u2009.22).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>UGAVA is a safe approach for CIED implantation and helps prevent an extra incision if a barrier is identified changing laterality preincision.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.14846","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T19:28:49Z","timestamp":1608319729000},"page":"458-465","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-0363","authenticated-orcid":false,"given":"Jonathan K.","family":"Chandler","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Kansas Health System Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nachiket","family":"Apte","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Kansas Health System Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagar","family":"Ranka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Kansas Health System Kansas City Kansas 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