Cephalic vein with a supraclavicular course: rare, but do not forget it exists!

We present a case of cephalic vein with a supraclavicular course during pacemaker implantation. This anomaly is very rare (0.2% in autopsy series) but you should bear in mind this possibility. In these cases, the vein must be abandoned (risk of lead fracture or skin erosion over the clavicle); moreover the guidewire must not be used to guide the puncture of the subclavian vein because of the risk of damage to vital structures.