Long-term central venous catheterization in patients with limited access.

Abstract

L ong-term central venous access is usually obtained by the deep veins of the neck and upper extremity I 1 1. With time, patients who require multiple or permanent central venous ‘ theters are at risk for thrombotic occlusion of all usual access routes. In the past. such patients underwent placement of central venous catheters by open surgery. This essay reviews the radiologic approaches to long-term central venous catheterization in patients with limited venous access. Patient Evaluation The first step in central venous c ttheterization of patients with limited access options is adequate venous imaging (by conventional venography, sonography, CT, or MR venography) to confirm occlusions and evaluate potential alternate routes of catheterization (Fig. I ). In some patients, a suitable vein may be identified that was previously thought to be occluded. Selective venography may be necessary to accurately define venous anatomy (Fig. 2). Cross-sectional imaging provides information about extravascular structures that may be contributing to the venous occlusion (such as tumor masses) or about vi:al organs that may lie in the path of potential percutaneous access routes.