{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T09:16:13Z","timestamp":1772183773173,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Ultrasound (US)-guided axillary vein puncture (AVP) is an established technique for cardiac implantable electronic device (CIED) implantation. Yet real-world data concerning shifting from conventional venous access into US-guided AVP are not widely available. Methods: This is a single-center prospective registry reporting safety (complications) and efficacy (success rate: i.e., accomplishment of the vein access utilizing only the initially employed approach) of self-taught US-guided AVP integration into the standard workflow of CIED procedures. Results: A total of 539 patients (mean age 71.5 \u00b1 12.4 years old, 78.7% males) were treated in our institution over a three-year period. Regarding CIED type and lead number, 58.3% used an implantable cardioverter defibrillator, 32% used permanent pacemakers, and two leads were involved in 65.8% of the cases and three leads in 8.9%. Before integration of US-guided AVP, the venous access success rate was 93.5%. The US-guided AVP success rate was 377\/400 procedures (94.2%). After the first semester of US-guided AVP utilization, a pattern of increased success rate was observed (p = 0.002) and remained stable over the following semesters. No major complication (periprocedural or 30-day mortality, hemothorax, pneumothorax and tamponade) occurred after US AVP integration in our workflow. Conclusions: The integration of US-guided AVP in a self-taught manner is feasible among electrophysiologists with experience in US-guided vascular access. A high success rate can be reached quickly and safely.<\/jats:p>","DOI":"10.3390\/medsci14010115","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T08:31:19Z","timestamp":1772181079000},"page":"115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying the Learning Curve in Ultrasound-Guided Vascular Access: Proficiency Metrics of Self-Taught Axillary Vein Puncture for CIED Implantation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2385-5365","authenticated-orcid":false,"given":"Dimitrios A.","family":"Vrachatis","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, National and Kapodistrian University of Athens, 11527 Athens, Greece"},{"name":"Electrophysiology and Pacing Department, Eugenideio Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0123-2615","authenticated-orcid":false,"given":"Konstantinos A.","family":"Papathanasiou","sequence":"additional","affiliation":[{"name":"Electrophysiology and Pacing Department, Eugenideio Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3062-360X","authenticated-orcid":false,"given":"Ioannis","family":"Anagnostopoulos","sequence":"additional","affiliation":[{"name":"Electrophysiology and Pacing Department, Eugenideio Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sotiria G.","family":"Giotaki","sequence":"additional","affiliation":[{"name":"Electrophysiology and Pacing Department, Eugenideio Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9355-400X","authenticated-orcid":false,"given":"Maria","family":"Kousta","sequence":"additional","affiliation":[{"name":"Electrophysiology and Pacing Department, Eugenideio Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Karavasilis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cG. Gennimatas\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Piperis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cG. Gennimatas\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiotis","family":"Tolios","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cG. Gennimatas\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Kaoukis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cG. Gennimatas\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Raisakis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cG. Gennimatas\u201d General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7287-3850","authenticated-orcid":false,"given":"Georgios","family":"Giannopoulos","sequence":"additional","affiliation":[{"name":"Third Department of Cardiology, Aristotle University of Thessaloniki, \u2018\u2019Hippokration\u2019\u2019 General Hospital, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodore G.","family":"Papaioannou","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerasimos","family":"Siasos","sequence":"additional","affiliation":[{"name":"Third Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9611-5002","authenticated-orcid":false,"given":"Spyridon","family":"Deftereos","sequence":"additional","affiliation":[{"name":"Electrophysiology and Pacing Department, Eugenideio Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.jacep.2020.01.006","article-title":"Subclavian and Axillary Vein Access Versus Cephalic Vein Cutdown for Cardiac Implantable Electronic Device Implantation","volume":"6","author":"Atti","year":"2020","journal-title":"JACC Clin. 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