Effect of Venous Tenting Puncture Technique on Complications in Cardiac Device Implantation via Axillary Access

ABSTRACT Background Axillary vein puncture (AVP) is an effective technique in cardiac implantable electronic device (CIED) implantation. This study evaluates the venous tenting (VnT) technique as a novel method and compares its effectiveness to contrast venography (CV) in reducing early and late complications. Methods This retrospective multicenter study included 464 patients who underwent CIED implantation using VnT or CV techniques. Patients were matched 1:1 and divided into two groups: Group 1 ( n = 232) included those who underwent VnT, and Group 2 ( n = 232) included those who underwent CV. Early complications, including pneumothorax (PTX), pocket hematoma (PH), and pocket infection (PI), were collectively defined as total complications (TC). Late complications were defined as device lead integrity (DLI). Independent predictors of complications were identified using multivariate logistic regression analysis. Results The TC rate was 5.2%. VnT significantly reduced PH rates (0.9% vs. 4.3%, p = 0.019) and TC rates (2.2% vs. 8.19%, p = 0.003) compared to CV. No significant differences were observed between the groups in PTX, PI, or DLI rates. Multivariate logistic regression analysis identified VnT as an independent protective factor for both TC ( p = 0.009) and PH ( p = 0.022). Conclusions During CIED implantation, the VnT technique was associated with lower TC and PH than the CV technique. This study highlights the potential of VnT to improve outcomes. Further prospective studies are recommended to confirm these findings.