Cephalic vein: the superficial vein on the thumb side of the arm

What it is

The cephalic vein is a large superficial vein on the lateral side of the upper limb.

Location

It begins from the lateral end of the dorsal venous network, ascends along the lateral forearm and the groove beside biceps and, in the deltopectoral groove, pierces the clavipectoral fascia to drain into the axillary vein. The median cubital vein joins it to the basilic vein.

Function

It drains the lateral side of the hand and forearm.

Body system

Cardiovascular · paired (left and right)

FMA ID

FMA13326 (Foundational Model of Anatomy)

Key facts

• It is commonly used for intravenous access.
• In the deltopectoral groove it is a surgical guide to the plane between deltoid and pectoralis major.

The cephalic vein begins in the anatomical snuffbox, from the radial (thumb) side of the superficial venous network on the back of the hand. It arches round the radial side of the lower forearm, runs up the anterolateral forearm, passes over the front of the elbow and climbs the anterolateral arm. (Radiopaedia: Cephalic vein.)

It lies in the subcutaneous tissue, above the deep fascia, for almost its whole length. TeachMeAnatomy groups it with the basilic vein as one of the two main superficial veins of the upper limb, both beginning in the dorsal venous network of the hand. (TeachMeAnatomy: Venous Drainage of the Upper Limb.)

OpenStax summarises its job: the cephalic vein drains blood from the superficial surface of the arm into the axillary vein. (OpenStax Anatomy and Physiology 2e, 20.5: Circulatory Pathways.)

At the wrist the cephalic vein crosses the anatomical snuffbox and runs superficial to the styloid process of the radius. In the forearm it ascends in the superficial fascia. At the elbow it lies along the lateral part of the elbow crease, in the groove between brachioradialis and biceps brachii. (Kenhub: Cephalic vein.)

In the snuffbox it lies near the superficial branch of the radial nerve, which runs in the same skin and subcutaneous tissue. (TeachMeAnatomy: The Anatomical Snuffbox.)

Higher up it runs superficial to the lateral cutaneous nerve of the forearm (lateral antebrachial cutaneous nerve), a sensory branch of the musculocutaneous nerve (C5 to C7). (Kenhub: Cephalic vein.)

In the arm it runs lateral to biceps brachii, then enters the deltopectoral groove, the furrow between deltoid and pectoralis major. A deltoid branch of the thoraco-acromial artery runs with it here. (Kenhub: Cephalic vein.)

At the top of the groove it reaches the clavipectoral (deltopectoral) triangle, pierces the clavipectoral fascia in the anterior wall of the axilla and drains into the first part of the axillary vein, above pectoralis minor. (Radiopaedia: Cephalic vein.)

By the time the cephalic vein joins it, the axillary vein has already formed, at the lower border of teres major, from the basilic vein and the paired brachial veins. The cephalic vein enters its first part, above pectoralis minor, and the axillary vein becomes the subclavian vein at the lateral border of the first rib. (Radiopaedia: Axillary vein.)

The cephalic vein drains the lateral part of the dorsal venous network of the hand, which itself receives blood from the palm, and collects small superficial veins from the lateral side of the forearm and arm. (Radiopaedia: Cephalic vein.)

One or more accessory cephalic veins may join it just below the elbow. They come either from a venous plexus on the back of the forearm or from the dorsal venous network of the hand. (Radiopaedia: Cephalic vein.)

At the elbow the median cubital vein leaves the cephalic vein just below the lateral epicondyle and runs obliquely across the cubital fossa to the basilic vein. It also sends a deep median vein to the veins beside the brachial artery, linking the superficial and deep systems. (TeachMeAnatomy: Median Cubital Vein.)

The pattern at the elbow varies. In the H-shaped pattern one median cubital vein links cephalic and basilic veins; in the M-shaped pattern the median antebrachial vein splits into a median cephalic vein and a median basilic vein. (Radiopaedia: Median cubital vein.)

Near the shoulder it often receives veins from the chest wall. In a dissection study of 40 limbs, the thoraco-acromial vein drained into the cephalic vein in 70% rather than directly into the axillary vein. (Lee H et al. The axillary vein and its tributaries are not in the mirror image of the axillary artery and its branches. PLoS One. 2019.)

Both veins begin in the dorsal venous network of the hand. The cephalic vein starts on its radial (thumb) side and runs up the lateral side of the limb; the basilic vein starts on its ulnar (little finger) side and runs up the medial side. The median cubital vein joins them at the elbow. (TeachMeAnatomy: Venous Drainage of the Upper Limb.)

The cephalic vein stays superficial to the shoulder and joins the axillary vein from in front, through the clavipectoral fascia. The basilic vein instead goes deep halfway up the arm, through the basilic hiatus, and joins the brachial veins at the lower border of teres major to form the axillary vein. (Radiopaedia: Basilic vein.)

The search phrase "cephalic artery" has no anatomical match in the arm: the cephalic vein has no artery of the same name. The artery nearest to it at the elbow is the brachial artery, which lies deeper, under the bicipital aponeurosis. (TeachMeAnatomy: Median Cubital Vein.)

The medial superficial vein, the basilic hiatus, PICC lines and dialysis fistulas. Basilic vein.

Reported variations include complete absence of the cephalic vein and drainage into the subclavian vein instead of the axillary vein. A course over the clavicle into the neck is rare, reported in about 0.2% of cases. (Shetty P et al. A rare case of persistent jugulocephalic vein and its clinical implication. Anat Cell Biol. 2016.)

In one such case the right cephalic vein climbed over the clavicle and opened into the external jugular vein, with a small branch to the axillary vein. The authors explain this as a persistent jugulocephalic vein: early in fetal life the cephalic vein drains into the external jugular vein, and only later connects to the axillary vein. (Shetty P et al. A rare case of persistent jugulocephalic vein and its clinical implication. Anat Cell Biol. 2016.)

The superficial veins of the upper limb are the easiest place to take blood, and the median cubital vein is the one used most often. (Kenhub: Cephalic vein.)

Radiopaedia lists the cephalic vein itself as a potential venepuncture site, and it is widely used for cannulas. (Radiopaedia: Cephalic vein.)

Near the shoulder the vein can be exposed through a small cut (cephalic vein cut-down) to pass pacemaker or defibrillator leads into the heart. Many implanters prefer this because it avoids the risks of a direct needle puncture, such as pneumothorax. A cephalic vein that runs over the clavicle into the neck can make the approach fail and should be avoided for pacemaker leads. (Shetty P et al. A rare case of persistent jugulocephalic vein and its clinical implication. Anat Cell Biol. 2016.)

The cephalic vein is also used to build arteriovenous fistulas for haemodialysis. In Japan, for example, radial-cephalic and brachial-cephalic fistulas are usually tried before a basilic vein fistula. (Deguchi J, Sato O. Transposed Brachial–Basilic Arteriovenous Fistula for Vascular Access in Japan. Ann Vasc Dis. 2018.)

Kenhub notes that varicose veins of the upper limb, including the cephalic vein, are very rare. (Kenhub: Cephalic vein.)

The nearest named structures in the 3D model, measured from the centre of each part:

• Inferior ulnar collateral artery · cardiovascular
• Median cubital vein · cardiovascular
• Basilic vein · cardiovascular
• Posterior ulnar recurrent artery · cardiovascular
• Superior ulnar collateral artery · cardiovascular
• Anterior ulnar recurrent artery · cardiovascular
• Radial recurrent artery · cardiovascular
• Recurrent interosseous artery · cardiovascular
• Middle collateral branch of deep brachial artery · cardiovascular
• Brachialis · muscular