{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T05:30:25Z","timestamp":1765344625502,"version":"3.46.0"},"reference-count":74,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Venous access selection represents a pivotal aspect of permanent pacemaker implantation, directly influencing both procedural safety and long-term device performance. Although the subclavian vein has been traditionally favored, its use is associated with notable risks, including pneumothorax, hemothorax, and crush syndrome. In contrast, axillary access has gained prominence, supported by observational studies and a small number of randomized trials demonstrating reduced pneumothorax rates, fewer arterial punctures, and potentially fewer long-term mechanical lead failures, particularly when ultrasound guidance is used. However, these findings are derived from heterogeneous studies with variable definitions, imaging protocols and operator experience, highlighting that evidence quality remains moderate. Contemporary advances\u2014such as routine ultrasound guidance, micropuncture techniques, and structured training\u2014have improved procedural consistency and safety, a trend reflected in recent guidelines. This review provides a focused appraisal of complication patterns, anatomical differences and patient-specific considerations to support individualized and evidence-aligned venous access selection in modern clinical practice.<\/jats:p>","DOI":"10.3390\/medicina61122173","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:17:36Z","timestamp":1765185456000},"page":"2173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Axillary Versus Subclavian Venous Access for Permanent Pacemaker Implantation: Complications, Evolving Techniques and Practical Recommendations"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7238-7117","authenticated-orcid":false,"given":"Georgios","family":"Aletras","sequence":"first","affiliation":[{"name":"Department of Cardiology, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece"},{"name":"School of Medicine, University of Crete, 70013 Heraklion, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1033-6856","authenticated-orcid":false,"given":"Spyridon","family":"Stavratis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ermis","family":"Hoda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Rogdakis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9958-2869","authenticated-orcid":false,"given":"Emmanuel","family":"Koutalas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University General Hospital of Heraklion, 71500 Heraklion, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Kanoupakis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University General Hospital of Heraklion, 71500 Heraklion, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1340-2282","authenticated-orcid":false,"given":"Emmanuel","family":"Foukarakis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e000177","DOI":"10.1136\/openhrt-2014-000177","article-title":"Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population","volume":"1","author":"Bradshaw","year":"2014","journal-title":"Open Heart"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA)","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur. 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