Balloon-assisted venous access salvage through a thrombosed arteriovenous graft.

Introduction: Maintaining vascular access by means of radiological intervention has become the mainstay of management of patients with central venous stenoses and occlusions (CVO), which can be challenging. We present a case of balloon-assisted percutaneous puncture of an occluded left subclavian vein, through a thrombosed arteriovenous graft, for a tunneled dialysis catheter insertion.

Methods: A thrombosed left arm arteriovenous graft was accessed, and the occluded left subclavian vein was traversed with 0.018 platform. An 8 mm 0.018 low platform balloon was inflated in the left subclavian vein as a target for percutaneous puncture to gain direct access into the occluded segment of the vein. This access was then used for routine placement of a tunneled left subclavian dialysis catheter.

Results: Successful placement of a tunneled dialysis catheter into an occluded left subclavian vein using a balloon- assisted puncture technique, through a thrombosed left-arm arteriovenous graft.

Conclusions: Thrombosed arteriovenous grafts are potential access sites into the central veins. Balloon-assisted punctures allow vascular access salvage into otherwise occluded segments of a central vein; in our case, it allowed access into an occluded left subclavian vein for dialysis catheter placement.