ReviewAxillary vein access for antiarrhythmic cardiac device implantation: a literature reviewSassone, Biagioa; Valzania, Cinziab; Laffi, Mattiac; Virzì, Santoa; Luzi, Mariod; for the Task Force on Imaging of the Italian Association of Arrhythmias and Cardiac Pacing (AIAC)Author Information aCardiology Division, SS.ma Annunziata Hospital, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Cento, Ferrara bCardiology Division, S. Orsola Hospital, University of Bologna, Bologna cCardiology Division, Villa Scassi Hospital ASL 3, Genova dCardiology Division, Ospedale Provinciale AREA VASTA 3, Macerata, Italy Correspondence to Biagio Sassone, MD, FAIAC, Cardiology Division, SS.ma Annunziata Hospital, Via Giovanni Vicini 2, Cento, 44042 Ferrara, Italy Tel: +39 51 683 8219; fax: +39 51 683 8119; e-mail: [email protected] Received 25 February, 2020 Revised 11 May, 2020 Accepted 31 May, 2020 Journal of Cardiovascular Medicine: April 2021 - Volume 22 - Issue 4 - p 237-245 doi: 10.2459/JCM.0000000000001044 Buy Metrics Abstract The current narrative review provides an update of available knowledge on venous access techniques for cardiac implantable electronic device implantation, with a focus on axillary vein puncture. Lower procedure-related and lead-related complications have been reported with extrathoracic vein puncture techniques compared with intrathoracic accesses. In particular, extrathoracic lead access through the axillary vein seems to be associated with lower complication incidence than subclavian vein puncture and higher success rate than cephalic vein cutdown. In literature, many techniques have been described for axillary vein access. The use of contrast venography-guided puncture has facilitated the diffusion of the axillary vein approach for device implantation. Venography may be particularly useful in specific demographic and clinical device implantation contexts. Ultrasound-guided or microwire-guided vascular access for lead positioning can be considered a valid alternative to venography, although current applications for axillary vein puncture need further evaluations. © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.