Introduction: Vascular access for transvenous pacemaker and cardioverter defibrillator implants is frequently obtained by using the cephalic cutdown technique.sometimes anatomical variations may limit insertion of one or several leads.We describe a case of a patient with an anomalous supraclavicular course of the left cephalic vein.case report: A 61-year-old male with background of ischemic heart disease, hypertension, diabetes mellitus, obstructive sleep apnea and dyslipidemia, was referred to our institution after four months of recurrent syncopal episodes.A bradycardiatachycardia syndrome was diagnosed and decided to proceed with permanent pacemaker implantation.through a cutaneous incision in the left deltopectoral groove, we dissected the tissue planes until the left cephalic vein became visible.Fluoroscopy in anterior-posterior projection showed clear supraclavicular course of the cephalic vein.