OBJECTIVE Contrast-guided axillary vein puncture is commonly used for pacemaker or defibrillator lead implantation. Venous spasm during contrast-guided axillary vein puncture has been reported rarely. We investigated the incidence of venous spasm during contrast-guided axillary vein puncture and the impact of venous spasm on axillary vein puncture. RESULTS Seventy-four consecutive patients referred for contrast-guided axillary vein puncture for pacemaker or defibrillator implantation were included in the study. The puncture was guided by fluoroscopy and the venogram of axillary vein. After the success of puncture, the venography was taken again. When the puncture could not be successful up to 3 min, the second venography was taken and the puncture was guided by the second venogram. The degree of venous spasm was evaluated by the reduction in the lumen calibre of the axillary vein after puncture. Mild venous spasm and severe venous spasm were defined as a reduction in the lumen calibre of 50-90 and ≥ 90%, respectively. The success rate of axillary vein puncture within 3 min was 87.8%, and the total success rate was 95.9%. Mild venous spasm occurred in 22 patients (29.7%) and severe venous spasm occurred in 6 patients (8.1%). Severe venous spasm occurred in all the three patients with a failed puncture. Severe venous spasm was independently negatively correlated with both success rate within 3 min and total success rate. CONCLUSIONS Venous spasm is not a rare phenomenon during the contrast-guided puncture of axillary vein and it has an important negative impact on the puncture.