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Long-term central venous access usually is achieved by placing a catheter into the superior vena cava through the upper extremity orjugular veins [1 , 2]. Alternative percutaneous approaches to the central veins are required when the subclavian and brachiocephalic veins no longer are available due to thrombosis related to instrumentation and hypercoagulable states [1]. These alternative approaches include translumbar puncture of the infrarenal inferior vena cava (IVC), transhepatic cannulation of the hepatic veins or intrahepatic IVC, and femoral venous catheterization [1-3]. The use of intercostal veins as alternative conduits for placing central venous catheters previously has required a surgical procedure [4-7]. In this article,we describe the cannulation of an intercostal vein via the basilic vein for placement of a long-term central venous access catheten in a patient with occlusion of the subclavian veins, brachiocephalic veins, and proximal superior vena cava.