{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:10:34Z","timestamp":1761808234623,"version":"3.40.5"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,27]],"date-time":"2018-12-27T00:00:00Z","timestamp":1545868800000},"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":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Axillary venous access with ultrasound guidance for pediatric transvenous lead implantation may reduce risks for pneumothorax and hemothorax. The objective was to retrospectively evaluate ultrasound\u2010guided axillary vein access as an alternative to the subclavian approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The technique consists of ultrasonographic identification of the axillary vein at the deltopectoral groove after initial contrast venography. A micropuncture kit is used for initial ultrasound\u2010guided percutaneous access with fluoroscopic confirmation of wire position. Pocket creation is performed, and sheath insertion and lead implantation proceed as usual. Demographic, procedural, and radiation exposure data were collected and analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixteen patients (median age\u00a0=\u00a013\u00a0years, 8\u201050 years; median weight\u00a0=\u00a056\u00a0kg, 29\u201077\u00a0kg) underwent lead implantation; two additional patients required fluoroscopy due to poor acoustic windows (89% success). Fifteen of 21 leads (71%) were ventricular; 50% of implants were pacemakers, and 31% were dual chamber. Median time to venous access was 13\u00a0min (interquartile range (IQR)\u00a0=\u00a09.25\u201020.25) and median implant procedure time was 156\u00a0min (IQR\u00a0=\u00a0112\u2010172). Median fluoroscopy time was 18.0\u00a0min (IQR\u00a0=\u00a011.9\u201029.6), median air kerma was 9.0\u00a0mGy (IQR\u00a0=\u00a03.0\u201028.5), and median dose\u2010area product was 30.2\u00a0Gy\u2010cm<jats:sup>2<\/jats:sup> (IQR\u00a0=\u00a016.1\u2010234.5). One patient required generator pocket revision 2\u00a0days postprocedure without lead dislodgement. There were no other complications encountered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Transvenous pacemaker and implantable cardioverter\u2010defibrillator lead implantation in the pediatric and adult congenital population through ultrasound\u2010guided axillary venous access is safe and efficacious. This technique may provide a low\u2010risk alternative for vascular access for pediatric implantation procedures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13567","type":"journal-article","created":{"date-parts":[[2018,12,5]],"date-time":"2018-12-05T07:08:37Z","timestamp":1543993717000},"page":"166-170","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Ultrasound\u2010guided axillary venous access for pediatric and adult congenital lead implantation"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8186-8471","authenticated-orcid":false,"given":"Bradley C.","family":"Clark","sequence":"first","affiliation":[{"name":"Division of Cardiology Children's Hospital at Montefiore  New York City New York"},{"name":"Department of Pediatrics Albert Einstein College of Medicine  New York City New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher 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