Trial reportEuropean heart journal2023
Intra-pocket ultrasound-guided axillary vein puncture vs. cephalic vein cutdown for cardiac electronic device implantation: the ACCESS trial.
Trial report in European heart journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04649788 (Prospective Randomized Comparison of Efficacy and Safety of Ultrasound-guided Axillary Vein Access Versus Cephalic Venous Cutdown for Implantation of Cardiac Electronic Devices), which is not on this map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Prospective Randomized Comparison of Efficacy and Safety of Ultrasound-guided Axillary Vein Access Versus Cephalic Venous Cutdown for Implantation of Cardiac Electronic Devices
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Ultrasound-guided vs. fluoro-guided axillary venous access for cardiac implantable electronic devices: a patient-based meta-analysis.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Pooled it
- Effect of Venous Tenting Puncture Technique on Complications in Cardiac Device Implantation via Axillary Access.Pacing and clinical electrophysiology : PACE · 2026Observational
- Ultrasound-guided axillary access outperforms subclavian puncture for cardiac implantable electronic device implantation: A network meta-analysis of 130,831 patients.Heart rhythm O2 · 2026Review
- Implementation of transcutaneous ultrasound-guided axillary vein access for implantations, revisions and upgrades of cardiac implantable electronic devices in a large tertiary care center.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Quantifying the Learning Curve in Ultrasound-Guided Vascular Access: Proficiency Metrics of Self-Taught Axillary Vein Puncture for CIED Implantation.Medical sciences (Basel, Switzerland) · 2026Article
- Outcome of Ultrasound-Guided Versus Fluoroscopy-Guided Versus Cephalic Cutdown Permanent Pacemaker Implantation.Cureus · 2026Article
- Case Report: Electrode perforation with normal pacemaker parameters leading to hemorrhagic shock: a rare case report of the "penetration-exit-re-entry" phenomenon.Frontiers in medicine · 2026Article
- Axillary Versus Subclavian Venous Access for Permanent Pacemaker Implantation: Complications, Evolving Techniques and Practical Recommendations.Medicina (Kaunas, Lithuania) · 2025Review
- Optimizing Ultrasound-Guided Placement of Cardiac Implantable Electronic Devices: Current Uses and Challenges.Echocardiography (Mount Kisco, N.Y.) · 2025Review
- Ultrasound Guided Venous Access for Cardiac Devices: Defining Learning Curve for Safety, Efficacy, and Radiation Exposure.Pacing and clinical electrophysiology : PACE · 2025Article
- Long-Term Complications Related to Cardiac Implantable Electronic Devices.Journal of clinical medicine · 2025Review
- Ultrasound-Guided Axillary Vein Puncture Versus Landmark-Guided Approach for Cardiac Implantable Electronic Device Placement.Pacing and clinical electrophysiology : PACE · 2025Observational
- Clinical Decision Making and Technical Approaches in Implantable Cardioverter-Defibrillator Procedures: A Step by Step Critical Appraisal of Literature.Reviews in cardiovascular medicine · 2024Review
- Ultrasound-Guided Axillary Access Using a Micropuncture Needle Versus Conventional Cephalic Venous Access for Implantation of Cardiac Devices: A Single-Center Randomized Trial.Journal of personalized medicine · 2024Article
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
aimsIntra-pocket ultrasound-guided axillary vein puncture (IPUS-AVP) for venous access in implantation of transvenous cardiac implantable electronic devices (CIED) is uncommon due to the lack of clinical evidence supporting this technique. This study investigated the efficacy and early complications of IPUS-AVP compared to the standard method using cephalic vein cutdown (CVC) for CIED implantation.
methodsACCESS was an investigator-led, interventional, randomized (1:1 ratio), monocentric, controlled superiority trial. A total of 200 patients undergoing CIED implantation were randomized to IPUS-AVP (n = 101) or CVC (n = 99) as a first assigned route. The primary endpoint was the success rate of insertion of all leads using the first assigned venous access technique. The secondary endpoints were time to venous access, total procedure duration, fluoroscopy time, X-ray exposure, and complications. Complications were monitored during a follow-up period of three months after procedure.
resultsIPUS-AVP was significantly superior to CVC for the primary endpoint with 100 (99.0%) vs. 86 (86.9%) procedural successes (P = .001). Cephalic vein cutdown followed by subclavian vein puncture was successful in a total of 95 (96.0%) patients, P = .21 vs. IPUS-AVP. All secondary endpoints were also significantly improved in the IPUS-AVP group with reduction in time to venous access [3.4 vs. 10.6 min, geometric mean ratio (GMR) 0.32 (95% confidence interval, CI, 0.28-0.36), P < .001], total procedure duration [33.8 vs. 46.9 min, GMR 0.72 (95% CI 0.67-0.78), P < .001], fluoroscopy time [2.4 vs. 3.3 min, GMR 0.74 (95% CI 0.63-0.86), P < .001], and X-ray exposure [1083 vs. 1423 mGy.cm², GMR 0.76 (95% CI 0.62-0.93), P = .009]. There was no significant difference in complication rates between groups (P = .68).
conclusionsIPUS-AVP is superior to CVC in terms of success rate, time to venous access, procedure duration, and radiation exposure. Complication rates were similar between the two groups. Intra-pocket ultrasound-guided axillary vein puncture should be a recommended venous access technique for CIED implantation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.