Balloon-assisted venous access salvage through a thrombosed arteriovenous graft.

INTRODUCTION

Maintaining vascular access by means of radiological intervention has become the mainstay of management of patients with central venous stenoses and occlusions (CVO), which can be challenging. We present a case of balloon-assisted percutaneous puncture of an occluded left subclavian vein, through a thrombosed arteriovenous graft, for a tunneled dialysis catheter insertion.

METHODS

A thrombosed left arm arteriovenous graft was accessed, and the occluded left subclavian vein was traversed with 0.018 platform. An 8 mm 0.018 low platform balloon was inflated in the left subclavian vein as a target for percutaneous puncture to gain direct access into the occluded segment of the vein. This access was then used for routine placement of a tunneled left subclavian dialysis catheter.

RESULTS

Successful placement of a tunneled dialysis catheter into an occluded left subclavian vein using a balloon- assisted puncture technique, through a thrombosed left-arm arteriovenous graft.

CONCLUSIONS

Thrombosed arteriovenous grafts are potential access sites into the central veins. Balloon-assisted punctures allow vascular access salvage into otherwise occluded segments of a central vein; in our case, it allowed access into an occluded left subclavian vein for dialysis catheter placement.