A wire transposition technique for recanalization of chronic complex central venous occlusions.

[thoracic outlet syndrome]

A minimal-invasive interventional technique for recanalization of complex chronic central venous total occlusions is described to overcome difficulties in case of failure of common approaches .We present a patient with a central venous occlusion that caused severe venous congestion of her upper extremity and significant impairment of her forearm hemodialysis shunt . Since the usual transbrachial and transfemoral attempts for recanalization of occluded right subclavian , brachiocephalic , superior vena cava , and proximal internal jugular veins (IJV ) failed , the approach was changed to a transjugular access . Only the IJV and subclavian vein occlusions were passed from transjugular .The key procedure was the switch of a jugular-brachial wire to a femoral -brachial setting . The wire transposition was achieved by snaring the looped stiff end of the jugular-brachial wire outside the jugular sheath from the opposite femoral access .Different approaches should be considered for the recanalization of challenging central venous occlusions . After failed attempts via common access sites , a guidewire transposition maneuver using a combined approach may be particularly helpful for safe and effective endovascular treatment of complex situations .