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Each approach has its advantages and hazards that need to be considered for the individual patient and balanced against the skills of the operator. The benefits of ultrasound guided venous access in reducing radiation exposure to the patient and implanter, avoiding the need for angiographic contrast and in minimizing the risk of pneumothorax and inadvertent arterial puncture are highlighted. Trainees should be taught each approach to deal with patient variability. Ultrasound guidance should be considered as a mainstream option for most patients.<\/jats:p>","DOI":"10.1002\/joa3.12639","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T14:03:57Z","timestamp":1632751437000},"page":"1506-1511","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Axillary vein access using ultrasound guidance, Venography or Cephalic Cutdown\u2014What is the optimal access technique for insertion of pacing leads?"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9899-7667","authenticated-orcid":false,"given":"Lloyd","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Cardiology Westmead Hospital Sydney New South Wales Australia"},{"name":"Westmead Private Hospital Sydney New South Wales Australia"},{"name":"University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Chik","sequence":"additional","affiliation":[{"name":"Department of Cardiology Westmead Hospital Sydney New South Wales Australia"},{"name":"Westmead Private Hospital Sydney New South Wales Australia"},{"name":"University of Sydney Sydney New South Wales Australia"},{"name":"The University of Notre Dame Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5643-5076","authenticated-orcid":false,"given":"Saurabh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Cardiology Westmead Hospital Sydney New South Wales Australia"},{"name":"Westmead Private Hospital Sydney New South Wales Australia"},{"name":"University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopal","family":"Sivagangabalan","sequence":"additional","affiliation":[{"name":"Department of Cardiology Westmead Hospital Sydney New South Wales Australia"},{"name":"Westmead Private Hospital Sydney New South Wales Australia"},{"name":"University of Sydney Sydney New South Wales Australia"},{"name":"The University of Notre Dame Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart P.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Cardiology Westmead Hospital Sydney New South Wales Australia"},{"name":"Westmead Private Hospital Sydney New South Wales Australia"},{"name":"University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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