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Review
. 2015 Mar;32(1):57-60.
doi: 10.1055/s-0034-1396966.

Percutaneous management of chronic central venous occlusive disease

Matthew G Gipson  1 , Rajan K Gupta  1 , Mitchell T Smith  1
Affiliations
Review

Percutaneous management of chronic central venous occlusive disease

Matthew G Gipson et al. Semin Intervent Radiol. 2015 Mar.
No abstract available

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Figures

Fig. 1
Fig. 1
A 55-year-old woman with a history of ovarian cancer and indwelling port-a-cath device who presented with progressive onset of facial swelling, plethora, and hoarseness. (a) Coronal reformatted contrast-enhanced CT of the thorax demonstrates numerous neck and mediastinal collaterals with thrombus surrounding the distal tip of the port-a-cath (arrow) and severe SVC stenosis (black arrowhead). (b) SVC venogram demonstrates focal severe stenosis with filling of collaterals; the lesion had been successfully traversed easily with a catheter and Glidewire (Terumo Medical Corp., Somerset, NJ). (c) During venoplasty, inflation of a 10-mm balloon demonstrates a focal waist with initial venoplasty. (d) Post–stent placement SVC venogram demonstrates in-line flow into the right atrium; no collaterals are seen, suggested a good hemodynamic response. CT, computed tomography; SVC, superior vena cava.
Fig. 2
Fig. 2
A 58-year-old woman with end-stage renal disease on chronic hemodialysis presents with a 2 month history of left upper extremity and facial swelling. (a) Tandem left-sided brachiocephalic and SVC venograms performed through angled catheters (arrowheads) demonstrate short-segment occlusion of the SVC with numerous neck and mediastinal collaterals (sheath tips—arrows). (b) Fluoroscopic spot image and venogram after sharp recanalization of the occlusion from a caudal approach with a 65-cm 21-gauge Chiba-tipped needle (Cook Inc., Bloomington, IN) demonstrates intravascular position of the needle tip (arrows). (c) Fluoroscopic spot image and tandem venogram shows “through-and-through” access after snaring a microwire (arrowheads) through the sheath (arrow); this was exchanged for an exchange length 0.035-in. wire to perform balloon venoplasty and stent placement. SVC, superior vena cava.
Fig. 3
Fig. 3
A 60-year-old woman with end-stage renal disease on chronic hemodialysis who presents with progressive left-sided neck and facial swelling. (a) Early and late left-sided cephalic arch venograms demonstrate short segment central occlusion with reconstitution of the brachiocephalic vein by a large tortuous neck collateral (sheath/angled catheter placed in the ipsilateral subclavian vein—arrowhead). (b) Fluoroscopic spot image demonstrates RF wire (arrowheads) and RF wire tip (arrow) positioned in an angled catheter (white arrowhead); loop snare positioned in the patent portion of the cephalic arch used as a target. (c) Fluoroscopic spot image shows 8-mm balloon catheter venoplasty after “through-and-through” access gained and 14-mm stent (LifeStar—Bard Medical, Covington, GA) placement. (d) Postprocedure cephalic arch venogram demonstrates improved in-line flow through stented segment with reduction of collateral filling. RF, radiofrequency.
See this image and copyright information in PMC

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