R oleofCentralVeinAngiography
w ithT DC InsertionorExchange:
Alw aysoratT im es?
T ony S am aha,M D
T heKidney and HypertensionCenter
Cincinnati,O hio
asam aha6@ gm ail.com
T oDoorN otT oDoaVenogram ?
• T hecaseagainstvenogram s:
– T hegood oledays…
– T hecostcontainm entintheeraofreim bursem entcuts...
– R adiocontrastadversereaction...S evere:0.2% ionicICM and 0.04% for
nonionicICM ;very severe:0.04% forionicICM and 0.004% fornonionicICM
P reservationofresidualrenalfunction...
T akestoom uchtim e...
T heanatom y isthesam eineveryone...
S hould only bedonew henthereisah/opriorcentralcatheters,
orm aybeifsom ethingain’trightorthew irekeepscurlingup...
– Ijustdon’tbelieveinit,itisjusta“ bunchofm alarkey”...
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–
–
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T DC Insertion:
O .R .Inserted T DC,N oFluoro,N oVenogram
T DC insertion:
O .R .Inserted T DC,N oFluoro,N oVenogram
T DC insertion:
O .R .Inserted T DC w ithFluoro,N oVenogram
T DC Insertion:
O .R .Inserted T DC w ithFluoro,N ovenogram
T DC Insertion:
O .R .Inserted T DC w ithFluoro,N oVenogram
T DC Insertion:
O therAnatom icConsiderations
The “slit” RA factor
T DC Insertion:
O therAnatom icConsiderations
• P revalenceofleftS VC:0.3-2%
Left Br-Ceph. (innominate) Vein is small
or absent in 60-70% of left SVC (PLACV)
Right SVC is
present in 8090% of left
SVC (PLACV)
T DC Insertion:
O therAnatom icConsideration
• Carotid artery w ire:M edialcourse
• Jugularveinw ire:L ateralcourse
Courtesy T edS aad,M D
T DC insertion:
O therAnatom icConsideration
New R-IJ cannulation
& central venography
Lateral wall of SVC
Courtesy T edS aad,M D
CentralVeinS tenosis:
How Early Could ItO ccur?
IJV stenosis occurring 1week after
temporary catheter placement
CentralVeinS tenosis:
Venogram and Fluoroscopy Guided S alvage
Upper IJV
Lower IJV
CentralVeinS tenosis:
Venogram and Fluoroscopy Guided S alvage
Micro Access Wire
10x4 Angio.
Balloon
CentralVeinS tenosis:
Venogram and Fluoroscopy Guided S alvage
CentralVeinS tenosis:
Venogram and Fluoroscopy Guided S alvage
CentralVeinS tenosis:
Venogram and Fluoroscopy Guided S alvage
CentralVeinS tenosis:
Venogram and Fluoroscopy Guided S alvage
CentralVeinS tenosis:
Venogram and Fluoroscopy Guided S alvage
CentralVeinS tenosis:
Venogram and Fluoroscopy Guided S alvage
T DC Exchange:
Fibro-epithelialS heath
Fibro-epithelialS heath:
BalloonDisruption
Fibro-epithelialS heath:
IrrespectiveofCatheterDesign…
T DC exchange:
CentralVeinT hrom bosis
InS um m ary,
• T herearesom any unknow ns… Accessingthecentralveins
w ithaclearerroadm apisbetteroffthangoingin
com pletely blind orw ithfluoroscopy alone...
• 1/1000 com plicationis1 toom any and could belife
threatening...
• T hestandard ofcareshould be (w ithsom eexceptions):
– T DC insertion:U /S guided cannulation (21gneedle,0.018w ire,
3fr/5fr) Venogram  Fluoros
copy forguidew irem anipulation
intoIVC & tractdilationand T DC insertion/positioning
– T DC exchange:Fluoroscopy guided guidew irem anipulationto
IVC  T DC rem oval S heathinsertionand venogram 
Addressingabnorm alfindings Fluoroscopy guided new T DC
insertion/positioning