Superior vena cava (SVC) occlusion is a major complication in hemodialysis patients, impairing access function and requiring timely intervention. A 69-year-old man undergoing maintenance hemodialysis for 8 years presented with a 1-month history of inadequate flow in a left upper-arm arteriovenous graft (AVG). Physical examination revealed prominent chest and abdominal wall veins with a caput-medusae pattern. DSA showed multiple venous stenoses, and complete SVC and right subclavian vein occlusion. Using coronary guidewires and microcatheters, the occluded segments were successfully recanalized, followed by SVC angioplasty and the placement of a covered stent. Postoperatively, venous dilation and facial edema resolved, and AVG function improved. This case illustrates the feasibility of adapting coronary guidewire and microcatheter techniques as an alternative approach for recanalization of complex central venous occlusion in selected hemodialysis patients.
Li et al. (Sat,) studied this question.