title: Balloon-assisted venous access salvage through a thrombosed arteriovenous graft.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore - Singapore.
authors.forename: Chen Pong
authors.initials: CP
authors.lastname: Wong
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore - Singapore.
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Damodharan
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore - Singapore.
authors.forename: Thijs A J
authors.initials: TA
authors.lastname: Urlings
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore - Singapore.
authors.forename: Sivanathan
authors.initials: S
authors.lastname: Chandramohan
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010690:Phlebography; D011677:Punctures; D006435:Renal Dialysis; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency