Cephalic Vein Cutdown

Updated: Mar 02, 2023
  • Author: Adam S Budzikowski, MD, PhD, FHRS; Chief Editor: Vincent Lopez Rowe, MD, FACS  more...
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Central venous access via the upper-extremity veins is used for various purposes because it is easy to perform and is convenient for the patients. The relatively low mobility of the central veins of the upper extremity and the neck also places low mechanical stress on the indwelling hardware.

Cephalic vein cutdown results in low complication rates, particularly as compared with those of subclavian vein cannulation [1] ; in particular, it poses little risk of pneumothorax. [2] This technique is widely used for the placement of pacing and defibrillation leads and chronic indwelling venous catheters. [3, 4, 5, 6]  In most patients, the cephalic vein is accessible for placement of long-term indwelling vascular devices. [7]

For information on other techniques for obtaining central venous access through upper-extremity veins, see Central Venous Access via Supraclavicular Approach to Subclavian Vein and Central Venous Access via Infraclavicular (Subclavian/Subclavicular) Approach to Subclavian Vein.



Indications for cephalic vein cutdown include the following:

  • Placement of pacing leads [2, 8, 9]
  • Central venous access for long-term infusion therapy - A meta-analysis by Klaiber et al found open cephalic vein cutdown to be generally superior to closed cannulation of the subclavian vein for implantation of totally implantable venous access ports (TIVAPs) [10]
  • Placement of temporary central venous catheters


Contraindications for cephalic vein cutdown include the following:

  • Known occlusion of the cephalic vein
  • Chronic ipsilateral venostasis
  • Ipsilateral radical resection of the lymph nodes
  • Ipsilateral mastectomy
  • Chronic ipsilateral  lymphedema
  • Extensive scarring of the incision site (this may increase the risk of infection or the erosion of an implanted device left in place for an extended period)
  • Ongoing ipsilateral phlebitis (this increases the risk of infection of an indwelling device)

Technical Considerations


Approximately 95% of individuals have a cephalic vein. About 80% of the time, this vein is located superficially in the deltopectoral groove. Rarely, deep exploration is needed to identify the vein.

The vein diameter ranges from 0.1 to 1.2 cm, with an average size of 0.8 ± 0.1 cm. The average length is about 4.8 cm. In 0.2% of cases, the vein has a supraclavicular course and should not be used for pacing lead insertion, because it exposes the hardware to mechanical stress and risk of fracture. Often, the vein receives two or three tributaries, but these rarely cause difficulty with accessing the vein. [11]



With the direct cutdown technique, cannulation can be achieved in 64-94.8% of cases for placement of pacing leads. [4, 5]

The success of the procedure increases when preoperative ultrasonographic mapping is done or contrast venography is performed to visualize the cephalic vein. [12, 13, 14]