Right heart catheterization via hemiazygos-azygos collaterals in the setting of inferior vena cava stenosis

Figures

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  Fig. 1. Fluoroscopy: Femoral Access Showing Collateral Entry. A. Right side large bore femoral dialysis catheter, which is going past the area of IVC narrowing (above the field of view). The cardiac catheter enters from a left femoral approach, goes to the IVC, then curves into a left lumbar vein at the area of narrowing. B. Fluoroscopy: Right Heart Catheter in Azygos System. B. Right heart catheter goes through the SVC into the azygous vein. C. Venography: Lumbar Collateral and Infrarenal IVC Stenosis. C. Left popliteal venogram showing infrarenal IVC stenosis around the catheter. Additional large lumbar vein through which the cardiac catheter advanced. D. CT Angiography: Hemiazygos-to-Azygos Collateral Drainage. D. CT scan showing the dilated hemiazygos vein crossing to the right side, joining the azygos vein, and draining into the SVC. This is believed to be the path the cardiac catheter took

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  Fig. 2. Fluoroscopy: Wire Path Deviating from IVC Course. This X-ray shows wire (red dashed line) during sheath insertion took a course that is not identical to the right femoral vein dialysis catheter, implying the wire is not in IVC

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  Fig. 3. Fluoroscopy: Catheter Route Through Hemiazygos and Right Heart. This X-ray shows the catheter, from the hemiazygous vein (red arrow), enters SVC (yellow arrow), and from there on took an usual course through RA (blue), RV (green), PA (purple), and wedge position (brown).