Recanalization of occluded veins to provide access for central catheter placement

THE indications for central venous catheter placement have expanded in recent years. Different types of temporary and long-term central catheters are now available (1) and are used for total parenteral nutrition (TPN), chemotherapy, long-term antibiotic treatment, hemodialysis, hemodynamic monitoring, medication administration, and body-fluid shunts (2). An increasing number of patients require these central catheters for long periods to complete or maintain their management. Pericatheter and central vein thrombosis is a frequent complication and usually requires catheter removal for temporary improvement; catheter replacement at a different site is the rule in patients who must continue treatment. However, patients who have undergone multiple catheterizations of the central veins develop complete venous occlusion or varying degrees of venous stenoses (2-4) and this constitutes a clinical problem that can be very difficult to manage (2,5,6). Several alternative approaches have been described for the placement of central catheters in patients with occluded veins, and include surgical, percutaneous, and combined surgical and percutaneous techniques (1,2,5-11). The purpose of this article is to describe the feasibility of percutaneous placement of temporary and long-term central catheters in patients with access problems by using guide-wire recanalization of the occluded veins. This method for catheter placement could be used as a reasonable alternative to the translumbar, intrahepatic, or intercostal approaches.