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I would like to acknowledge and commend the timely and informative article written by Di Carlo et al¹ in the September 2001 issue of the ARCHIVES that described the placement of totally implantable venous access devices using the cephalic vein cutdown approach as the preferred insertion technique. However, I believe that several aspects of their article warrant reflection and discussion.

The first detailed description of the cephalic vein cutdown approach for long-term indwelling central venous access was published in 1976 by Heimbach and Ivy.² Since that time, numerous articles have been published describing this technique, with some series specifically reporting the frequency of successful catheter placement with the cephalic vein cutdown approach (cumulative results from 9 such series: 80.8%, or 1785 of 2210 patients). In the article by Di Carlo et al,¹ the authors fail to give well-deserved recognition to Heimbach and Ivy for their detailed initial description of the . . . [Full Text of this Article]

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