Intracath AV Shunt

The right groin is prepped and draped. 5ml of 1% lidocaine applied.

The patient is systematically heparinized. Access to the right common femoral vein is achieved with a micropuncture set . Standard over the wires were exchange perfomed for a 6 french vascular sheath. The catheter was advanced over wires to the Superior venacava and selective superior venacavogram was perfomed.

The catheter and wire combination are then utilized to cross the left subclavian innominate vein/subclavian venous occlusion an selective left subclavian venogram is perfomed with the catheter in the left subclavian vein. Multiple attempts are made under fluoroscopic guidance and with roadmap contraol to cross the area of occlusion within the eft subclavian and left axillary region. these were unsuccessful.

Access to the left forearm AVF is achieved with a micropuncture set. Sonographic augmentation is obtained with scanner and larger changes performed for a 6 French vascular sheath. the catheter is advanced over the wire into the left cephalic vein and left cephalic venogram is perfomed. there is again demonstrated total occlusion of the left axillary vein and left subclavian vein with multiple prominent chest wall and lower neck collateral vasculature reconstituting the left innominate vein.

The catheters, wires and sheaths were removed and hemostasis achieved.

Impression.

Successful ultrasound guided vascular access x 2 as described.

Successful selective left subclavian venogram

Successfule left subclavian venogram revealing total occlusion of the left subclavian vein and left axillary vein.

Successfule left forearm fistulogram from the arterial inflow to the right atrium desmosntrate outflow through the multiple prominent venous collaterals.

Successful selective left cephalic venogram demonstrating total occlusion of the left axillary vein and left subclavian vein secondary to the previously placed left chest AICD.

Multiple attempts at crossing the areas of axillary venous and subclavian venous occlusion from the both the femoral approach and from combinations were unfortunately unsuccessful.

Intracath AV Shunt