Percutaneous Access of the Superior Vena Cava in Patients With Bilateral Jugular-Subclavian Vein Occlusion Using Wire-Target Access for Placement of Tunneled Hemodialysis Catheters

Abstract

The purpose of this study was to present the use of “wire-target” access at the jugular-subclavian vein junction for performing percutaneous superior vena cava (SVC) access in patients with bilateral jugular-subclavian vein occlusion requiring tunneled hemodialysis catheter placement, thereby avoiding groin access use. A 3-year retrospective review of all wire-target SVC accesses for tunneled hemodialysis catheter placement performed at our institution was conducted. There were a total of four patients requiring this. Description of the technique in adults and review of intraoperative imaging are presented (Figs 1 and 2). The femoral vein is accessed percutaneously using the modified Seldinger technique, and a 5F sheath is inserted. This is followed by placement of a pigtail catheter (“wire-target”) in the SVC with flush superior venacavography and jugular-subclavian vein junction venography (Fig 1). Using wire-target access (pigtail location) of the jugular-SVC junction, the SVC is percutaneously cannulated at the level of the pigtail catheter under fluoroscopy, and a guidewire is passed into the inferior vena cava with confirmation by injection of contrast material (Fig 2). A tunneled dialysis catheter is then placed from above. The pigtail catheter is removed from the SVC. Tunneled hemodialysis catheter placement in adults with upper extremity venous occlusion can be challenging if not impossible, usually necessitating femoral catheter placement with all of its attendant morbidity. The wire-target technique of SVC access is a procedure that can be used safely and effectively to establish upper body catheter access when traditional techniques for tunneled dialysis catheter placement are not possible.Fig 2Guidewire.View Large Image Figure ViewerDownload Hi-res image Download (PPT)