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 cath eters are now available (1) and are used for total parenteral nutritio n (TPN), chemotherapy, long-term antibiotic treatment, hemodialysis, h emodynamic monitoring, medication administration, and body-fluid shunt s (2). An increasing number of patients require these central catheter s for long periods to complete or maintain their management. Pericathe ter and central vein thrombosis is a frequent complication and usually requires catheter removal for temporary improvement; catheter replace ment at a different site is the rule in patients who must continue tre atment. However, patients who have undergone multiple catheterizations of the central veins develop complete venous occlusion or varying deg rees of venous stenoses (2-4) and this constitutes a clinical problem that can be very difficult to manage (2,5,6). Several alternative appr oaches have been described for the placement of central catheters in p atients with occluded veins, and include surgical, percutaneous, and c ombined surgical and percutaneous techniques (1,2,5-11). The purpose o f this article is to describe the feasibility of percutaneous placemen t of temporary and long-term central catheters in patients with access problems by using guide-wire recanalization of the occluded veins. Th is method for catheter placement could be used as a reasonable alterna tive to the translumbar, intrahepatic, or intercostal approaches.