Central venous access is an essential technique for cardiovascular implantable electronic device (CIED) implantation, and the use of axillary vein approach has recently been increasing. This study sought to examine whether real-time venography-guided extrathoracic puncture facilitates the procedure. We retrospectively analyzed 179 consecutive patients who underwent CIED implantation using the axillary vein puncture method. Patients were divided into two groups: the conventional method group (CG, n = 107) and the real-time venography-guided group (RG, n = 82). The application of real-time venography was at the discretion of individual operators. Operators with experience of less than 50 CIED implantations were defined as inexperienced operators in this study. Puncture duration and number of attempts were significantly less in the RG group than in the CG group (283 ± 198 vs. 421 ± 361 s, p < 0.01, and 3.19 ± 2.00 vs. 4.18 ± 2.85, p < 0.01). These benefits of real-time venography were observed in inexperienced operators, but not in experienced operators. In addition, the success rate without extra attempts at puncture was higher in the RG group (54% vs. 32%, p < 0.01). Although the total amount of contrast medium was higher in the RG group (16.3 ± 4.1 mL vs. 11.9 ± 6.6 mL, p < 0.01), serum levels of creatinine pre- and post-operation were not different in the two groups (p = NS). We concluded that real-time venography is a safe and effective method for axillary vein puncture, especially in inexperienced operators.

中心静脉通路是心血管植入式电子设备 (CIED) 植入的一项重要技术，最近腋静脉入路的使用越来越多。本研究旨在检查实时静脉造影引导的胸外穿刺是否有助于手术。我们回顾性分析了 179 名使用腋静脉穿刺法进行 CIED 植入的连续患者。患者分为两组：常规方法组（CG，n  = 107）和实时静脉造影引导组（RG，n = 82)。实时静脉造影的应用由个体操作者自行决定。在本研究中，具有少于 50 次 CIED 植入经验的操作者被定义为缺乏经验的操作者。RG 组的穿刺持续时间和尝试次数明显少于 CG 组（283 ± 198 vs. 421 ± 361 s，p  < 0.01，和 3.19 ± 2.00 vs. 4.18 ± 2.85，p  < 0.01）。在没有经验的操作者中观察到实时静脉造影的这些好处，但在有经验的操作者中没有观察到。此外，RG 组无需额外尝试穿刺的成功率更高（54% 对 32%，p  < 0.01）。尽管 RG 组的造影剂总量较高（16.3 ± 4.1 mL 对比 11.9 ± 6.6 mL，p < 0.01)，两组患者术前术后血清肌酐水平差异无统计学意义( p  = NS)。我们得出结论，实时静脉造影是一种安全有效的腋静脉穿刺方法，尤其是对于没有经验的操作者。