Asunto(s)
Venas Braquiocefálicas , Procedimiento de Fontan , Humanos , Procedimiento de Fontan/métodos , Venas Braquiocefálicas/cirugía , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/anomalías , Anomalías Linfáticas/cirugía , Masculino , Femenino , Cardiopatías Congénitas/cirugíaRESUMEN
PURPOSE: Ultrasound-guided supraclavicular catheterization (UGSC) of the brachiocephalic vein (BCV) for long-term tunneled central venous catheter (tCVC) insertion may be safer than the internal jugular vein approach due to its superior field of view. We examined the clinical outcomes of tCVC insertions performed by junior residents through UGSC of the BCV. PATIENTS AND METHODS: From January 2018 to December 2023, we assessed clinical outcomes and compared the experience levels of surgeons conducting tCVC insertions. Surgeons were categorized into three groups: junior residency (JR), senior residency (SR), and board-certified pediatric surgeons (BCPS). RESULTS: 177 tCVC insertions were done on 146 patients. Intraoperative complications included 6 cases of arterial puncture, 1 case of pneumothorax, 1 case of over insertion of catheter tip, and 1 case of suspected hemothorax. Distribution across groups was as follows: 28 cases (15.8%) in JR group, 92 (52.0%) in SR group, and 57 (32.2%) in BCPS group. Although the JR group exhibited longer operation times than the BCPS group, no significant differences in intraoperative complications were noted. CONCLUSION: Junior residents can safely perform UGSC for tCVC insertion. However, careful consideration of complications such as arterial or thoracic puncture is essential and case selection should be based on experience.
Asunto(s)
Cateterismo Venoso Central , Competencia Clínica , Internado y Residencia , Ultrasonografía Intervencional , Humanos , Cateterismo Venoso Central/métodos , Internado y Residencia/métodos , Ultrasonografía Intervencional/métodos , Femenino , Masculino , Estudios Retrospectivos , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Niño , Lactante , Preescolar , Catéteres Venosos Centrales , Venas Yugulares/diagnóstico por imagen , AdolescenteRESUMEN
OBJECTIVE: Failure to achieve timely arteriovenous fistulae (AVFs) utilization due to excessive depth (>6 mm) remains an ongoing concern for dialysis access. This study evaluates the outcomes of radiocephalic (RCF) and brachiocephalic (BCF) fistula elevation required for access utilization. METHODS: A retrospective review of all patients undergoing first-time autologous access over 10 years was undertaken. RCF and BCF were analyzed, and cases of initial access failure due to depth alone were selected for study. Primary and staged brachio-basilic AVF were excluded. Outcomes of early thrombosis, line placement, maturation (successful progression to hemodialysis [HD), reintervention, and functional dialysis (continuous HD for 3 consecutive months) were examined. RESULTS: From January 2012 to December 2022, 1733 patients (67% female; mean age, 61 ± 14 years) underwent autologous AVF placement. Of these, 298 patients (17%) had depth-related AVF access issues (BCF, 71% and RCF, 29%). Nineteen percent of these AVFs underwent a primary balloon-assisted maturation (BAM), and 2% had side branch coil embolization before consideration for elevation. The average time to intervention for depth was 11 ± 4 weeks after primary creation. During elevation, side branch ligation occurred in 38% of cases, and 15% underwent intraoperative BAM, The pre-elevation depth was 8.2 ± 3.1 mm, and the mean post-elevation depth was 4.7 ± 2.9 mm (P = .002). Early thrombosis (<18 days) occurred in 4% of cases. There was no mortality, and the 30-day major adverse cardiac event rate was 2%, with a 30-day morbidity of 5%, which was driven by wound issues. Six percent of the AVFs underwent follow-up BAM within 3 months. Mean maturation of the AVFs was 74% ± 3% vs 72% ± 3% (P = .58) for the elevation vs no-elevation groups at 24 weeks, respectively. However, there was an increase in tunneled central line placement in pre-emptive fistula patients due to the delay in maturation (elevation, 17% vs no-elevation, 8%; P = .008). There was a mean successful access time of 6 ± 3 weeks after elevation (16 ± 4 weeks after access creation). There was a median of 2.4 secondary interventions per year after elevation compared with a median of 2.7 secondary interventions per year without elevation. Mean access functionality was 68% ± 8% vs 75% ± 8% at 3 years for the elevation vs no-elevation groups, respectively (P = .25). CONCLUSIONS: Elevation of deep BCF and RCF occurs late after placement but can be successfully achieved with low morbidity and satisfactory long-term functionality. It results in an increase in tunneled central line placement in pre-emptive fistula patients. Elevation is a valuable adjunct to AVF maturation and enhances an autologous access policy.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Diálisis Renal , Humanos , Derivación Arteriovenosa Quirúrgica/efectos adversos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Factores de Tiempo , Anciano , Resultado del Tratamiento , Arteria Radial/cirugía , Factores de Riesgo , Grado de Desobstrucción Vascular , Embolización Terapéutica/efectos adversos , Arteria Braquial/cirugía , Venas Braquiocefálicas/cirugía , Venas Braquiocefálicas/diagnóstico por imagen , Extremidad Superior/irrigación sanguínea , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/terapia , Oclusión de Injerto Vascular/fisiopatologíaRESUMEN
A patient in his late 30s presented with issues of retrosternal chest pain and palpitations. He had sustained a splinter injury to the left hemithorax a year ago for which he had been managed with a tube thoracostomy. During subsequent evaluations, he was found to have atrial fibrillations and a CT angiography revealed an arch of the aorta pseudoaneurysm with a fistulous communication with the innominate vein, which being a rare condition has no established treatment protocols. Endovascular salvage of the condition required an aortic Ishimaru zone 2 deployment of the thoracic endovascular aortic repair stent graft to provide an adequate landing zone. The elective left subclavian artery revascularisation was obtained by a left carotid artery to left subclavian artery bypass. Post procedure there was complete exclusion of the pseudoaneurysm sac, and the fistulous aorto-venous communication inflow tract. The patient recuperated well and has returned to full active duties.
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Aneurisma Falso , Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Traumatismos Torácicos , Humanos , Masculino , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aorta Torácica/lesiones , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Diseño de Prótesis , Stents , Traumatismos Torácicos/cirugía , Resultado del Tratamiento , AdultoRESUMEN
Resection and reconstruction of the superior vena cava (SVC) are required in a selected group of patients with anterior mediastinal tumors and lung neoplasms. We present the case of a 63-year-old woman who underwent invasive type B2 thymoma resection and a rare type of reconstruction of the superior vena cava using a patch of the left brachiocephalic vein (LBV). The various types of reconstruction of the superior vena cava are discussed.
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Timoma , Neoplasias del Timo , Femenino , Humanos , Persona de Mediana Edad , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/cirugía , Vena Cava Superior/patología , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Venas Braquiocefálicas/patología , Mediastino/patología , Timoma/diagnóstico por imagen , Timoma/cirugía , Timoma/patología , Neoplasias del Timo/diagnóstico por imagen , Neoplasias del Timo/cirugía , Neoplasias del Timo/patologíaRESUMEN
A 63-year-old woman was admitted to our department for the investigation of superior vena cava (SVC) syndrome. Computed tomography revealed an azygos tumor extending into the SVC. Video-assisted thoracic surgery (VATS) was performed to remove the distal end of the azygos vein in the left lateral position, followed by complete resection of the entire tumor under median sternotomy in the supine position. The histological diagnosis was a primary angiosarcoma of the azygos vein. The patient was discharged without any complications and is now alive and tumor-free 24 months after surgery. In addition, contrast-enhanced computed tomography revealed no graft occlusion in the two reconstructed brachiocephalic veins. Thoracoscopic surgery in the lateral position is useful for safe and reliable complete resection of a tumor arising from the azygos vein.
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Hemangiosarcoma , Síndrome de la Vena Cava Superior , Femenino , Humanos , Persona de Mediana Edad , Vena Ácigos/cirugía , Vena Cava Superior/cirugía , Hemangiosarcoma/cirugía , Venas Braquiocefálicas/cirugía , Síndrome de la Vena Cava Superior/etiologíaAsunto(s)
Venas Braquiocefálicas , Diálisis Renal , Síndrome de la Vena Cava Superior , Humanos , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Venas Braquiocefálicas/fisiopatología , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/cirugía , Síndrome de la Vena Cava Superior/fisiopatología , Síndrome de la Vena Cava Superior/terapia , Resultado del Tratamiento , Atrios Cardíacos/cirugía , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Masculino , Fallo Renal Crónico/terapia , Fallo Renal Crónico/cirugía , Persona de Mediana Edad , Femenino , Factores de TiempoRESUMEN
INTRODUCTION: There is still debate on the best access route in case of bilateral internal jugular vein thrombosis. We aimed to compare the safety, effectiveness, and outcomes of tunneled dialysis catheter placement via supraclavicular brachiocephalic and femoral vein approaches in patients with bilateral internal jugular vein thrombosis. METHODS: Between January 2018 and December 2021, data of the patients in whom tunneled dialysis catheters were placed via the supraclavicular brachiocephalic vein (n = 42) and femoral vein (n = 57) approaches were extracted. Patient demographics, technical and clinical success rates, complications, and outcomes were noted. The Likert scale was used to assess patient satisfaction. FINDINGS: Forty two (42.4%) patients were men, and the mean age was 61.9 (range, 12-93) years. The technical and clinical success rate was 100% for both groups. No major complication was encountered. The mean follow-up period was 497.5 (range, 32-1698) catheter days. Thirty-day patency was similar for the brachiocephalic vein and femoral vein group (40 [95.2%] vs. 55 [96.5%], p = 0.754). Also, primary and cumulative patency rates were comparable (p = 0.158; p = 0.660). The infection rate was 2.6 and 4.1 per 1000 catheter days for the brachiocephalic vein and femoral vein group. The infection-free survival was significantly higher in the brachiocephalic vein group (71.9% vs. 35.3% at 12 months, p < 0.001). Patient satisfaction was higher in the brachiocephalic vein group (median satisfaction, 5 vs. 4, p < 0.001). DISCUSSION: Both supraclavicular brachiocephalic vein and femoral vein approaches have high technical and clinical success with comparable patency rates. However, low infection rate and high patient satisfaction make the supraclavicular brachiocephalic vein approach a reasonable alternative before proceeding to the femoral vein access.
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Cateterismo Venoso Central , Catéteres Venosos Centrales , Trombosis , Enfermedades Vasculares , Masculino , Humanos , Persona de Mediana Edad , Femenino , Diálisis Renal/efectos adversos , Cateterismo Venoso Central/efectos adversos , Venas Braquiocefálicas/cirugía , Venas Yugulares , Vena Femoral , Resultado del Tratamiento , Trombosis/etiología , Catéteres Venosos Centrales/efectos adversos , Catéteres de Permanencia/efectos adversosRESUMEN
CLINICAL DATA: Infant, 11-month-old, male, diagnosis of Tetralogy of Fallot with retrotracheoesophageal course of the brachiocephalic vein. Usual findings of Tetralogy of Fallot on physical examination. Technical description: Chest radiography showed slightly reduced pulmonary vascular markings and no cardiomegaly. Normal preoperative electrocardiogram with postoperative right bundle branch block. Usual findings of Tetralogy of Fallot on echocardiogram. Postoperative computed tomography angiography confirmed left brachiocephalic vein with anomalous retrotracheoesophageal course, configuring a U-shaped garland vein, in addition to postoperative findings of total correction of Tetralogy of Fallot. OPERATION: Complete surgical repair was performed with pulmonary valve commissurotomy and placement of bovine pericardial patch to solve right ventricular outflow tract obstruction, pulmonary trunk enlargement, and ventricular septal defect closure. COMMENTS: Systemic venous drainage may show variations in patients with Tetralogy of Fallot. These abnormalities are usually of little clinical relevance, as they are asymptomatic. We presented a rare case of retrotracheoesophageal course of an anomalous left brachiocephalic vein with intraoperative diagnosis, confirmed by imaging during postoperative follow-up, without compromising clinical management or surgical approach.
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Procedimientos Quirúrgicos Cardíacos , Defectos del Tabique Interventricular , Tetralogía de Fallot , Lactante , Humanos , Masculino , Animales , Bovinos , Tetralogía de Fallot/diagnóstico por imagen , Tetralogía de Fallot/cirugía , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Defectos del Tabique Interventricular/cirugía , Ecocardiografía , Procedimientos Quirúrgicos Cardíacos/métodosRESUMEN
OBJECTIVE: Brachiocephalic vein (BCV) obstruction can cause dialysis access dysfunction and failure. Central vein stenosis involving the BCV may require advanced endovascular procedures. We report that most BCV occlusions can be treated using simple endovascular techniques on an outpatient basis. METHODS: From January 2009 to January 2022, 115 hemodialysis patients underwent BCV endovascular revascularization. Seventy-three of the initial procedures were performed in an office-based angiosuite. Indications for the procedure were BCV occlusion endangering the performance of a previous arm access or making the creation of a new arm access unadvisable. We recorded and analyzed risk factors and procedural results, patency rates, complications, and mortality. RESULTS: The median age was 62 years (range, 23-91 years); 56% were female. Most prevalent associated conditions were diabetes mellitus (61%) and hypertension (68%). Fifty-six patients (48.7%) presented with severe upper extremity edema ipsilateral to the side of pre-existing functioning access. Obstruction recanalization was effective using standard catheter and wire in 106 cases (92.1%) and transseptal needle in nine cases (7.8%), that included seven using inside-out procedure. Initial management of the BCV stenosis was percutaneous transluminal balloon angioplasty alone in 74 patients (64.3%), stenting in 33 (28.7%), and HeRO conduit in eight cases (7%). Treatment of other central venous lesions included 49 cases (42.6%). The procedure was successful in 99.1% of patients. No intraoperative complications occurred. All 92 patients with previous arm access maintained adequate performance (100%). In 22 of 23 patients (95.6%), new upper extremity access creation was effectively performed after the venous intervention. Overall clinical success rate was 92%. The mean postoperative monitoring was 23 months, the median was 12 months, and the range was 1 to 84 months. During this monitoring period, 266 endovascular procedures, 91% in the office and 9% in the hospital, were required to preserve access performance. Eventually, 49 patients (42.6%) were stented. Eleven patients (9.56%) had infections, and six required complete access removal. Other causes of access failure included two patients with central vein thrombosis and one with massive pulmonary embolus. At the end, nine patients (7.8%) had access failure. Thirty-two patients (27.8%) died of unrelated causes during the follow-up period. Seventy-six patients (66%) have maintained functional access. Kaplan-Meier curves determined median primary patency of 9.6 months, median primary assisted patency of 56.2 months, and secondary patency of 75% at 80 months. CONCLUSIONS: Successful endovascular revascularization of BCV obstruction can be treated safely, with simple endovascular techniques in an office-based context with minor complication rates and durable results.
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Cateterismo Venoso Central , Procedimientos Endovasculares , Enfermedades Vasculares , Humanos , Femenino , Persona de Mediana Edad , Masculino , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Constricción Patológica/cirugía , Resultado del Tratamiento , Cateterismo Venoso Central/efectos adversos , Procedimientos Endovasculares/efectos adversos , Diálisis Renal/efectos adversos , Stents/efectos adversos , Estudios RetrospectivosRESUMEN
Intravascular lipomas (IVL) located in the superior vena cava (SVS) are rare benign primary venous tumors with less than 15 cases reported in the literature. We report a case of a 64-year-old woman with IVL of the SVC extending to the right brachiocephalic vein. She was treated successfully using a hybrid procedure which involved endovascular control of the right subclavian vein and surgical approach via median sternotomy followed by mass resection and use of pericardial patch for vein defect closure.
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Lipoma , Vena Cava Superior , Femenino , Humanos , Persona de Mediana Edad , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/cirugía , Resultado del Tratamiento , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Venas Braquiocefálicas/patología , Vena Subclavia , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Lipoma/patologíaRESUMEN
AIM: Percutaneous transluminal angioplasty or cephalic vein transposition to the axillary vein is mainly used for treatment of cephalic arch stenosis, a common complication of brachiocephalic fistulas. However, the results of such interventions have been disappointing. METHODS: We used a polytetrafluoroethylene prosthesis with a 6 mm diameter to bridge the cephalic vein and the ipsilateral external jugular vein, and successfully created a new drainage outlet and established immediate restoration of flow through brachiocephalic fistulas. RESULTS: This surgery allowed the cephalic venous arch and subclavian vein, which are vulnerable to stenosis, to be bypassed altogether and the puncture segment could be elongated by about 20 cm. CONCLUSION: It is a safe and effective alternative to traditional methods of treatment for cephalic arche stenosis.
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Derivación Arteriovenosa Quirúrgica , Vena Subclavia , Humanos , Vena Subclavia/cirugía , Vena Axilar/cirugía , Venas Yugulares/cirugía , Oclusión de Injerto Vascular/etiología , Grado de Desobstrucción Vascular , Venas Braquiocefálicas/cirugía , Constricción Patológica , Derivación Arteriovenosa Quirúrgica/efectos adversos , Diálisis Renal/efectos adversos , Resultado del TratamientoRESUMEN
We describe a subaortic left brachiocephalic vein, a congenital anomaly that can be suspected during the rapid central vein assessment before central venous catheterization. Since the vein descends vertically/obliquely rapidly from its origin, we suggest that the puncture should be made at a greater angle (50°-60°) than what is usually used to puncture this vein (20°-30°). Failure to identify this anomaly may cause a failed puncture or complications from the puncture of adjacent blood vessels.
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Venas Braquiocefálicas , Cateterismo Venoso Central , Humanos , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Ultrasonografía Intervencional , Cateterismo Venoso Central/efectos adversos , Ultrasonografía , PuncionesRESUMEN
BACKGROUND: Umbilical Venous Catheter (UVC) and Epicutaneo-Caval Catheters (ECC) are reference catheters in the neonatal period. However, many factors such as the corpulence of neonates, poor venous capital, and anatomical variants can complicate ECC insertion or make it impossible. In newborns with failed ECC insertion, we developed an hybrid technique that combines the insertion of a long-lasting silicone or polyurethane small caliber catheter, usually used as a ECC in newborns, with the ease and speed of ultrasound guided puncture of the brachiocephalic vein (BCV). METHODS: Three years retrospective single center experience of ultrasound guided BCV insertion of silicon or polyurethane small caliber central catheter in a tertiary neonatal intensive care in case of insertion fail of ECC. RESULTS: Twenty-one echo guided BCV-ECC insertions were performed in 20 newborns. Median age was 16 days (range: 0-110 days), median weight was 1700 g (range: 605-4960 g) at insertion. In most cases, insertion was on the left side (17/21). No failures were noted. Only one attempt was necessary in all cases. Insertion time, when noted, was always of <45 min. The median duration of use of these catheters was 11 days (range 3-35 days). No complication was noted during insertion or catheter use, including catheter-related infections and thrombosis. CONCLUSION: Echo guided percutaneous catheterization of the brachiocephalic vein with a long lasting silicone or polyurethane small caliber catheter is a safe alternative to the ECC if insertion has failed. However, it requires a mastery of ultrasound-guided insertion technique in term and premature neonates.
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Venas Braquiocefálicas , Cateterismo Venoso Central , Lactante , Recién Nacido , Humanos , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Estudios Retrospectivos , Poliuretanos , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Ultrasonografía Intervencional/métodos , Recien Nacido Prematuro , CatéteresRESUMEN
OBJECTIVES: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. METHODS: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. RESULTS: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient's symptoms. CONCLUSION: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy.
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Derivación Arteriovenosa Quirúrgica , Hipertensión , Masculino , Humanos , Adulto , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Constricción Patológica , Grado de Desobstrucción Vascular , Vena Subclavia/diagnóstico por imagen , Vena Subclavia/cirugía , Stents , Diálisis Renal , Derivación Arteriovenosa Quirúrgica/efectos adversos , Resultado del TratamientoRESUMEN
Partial anomalous pulmonary venous connection is reported to occur in 0.4 to 0.7% of children. Only 3% of these cases involve an anomalous left-sided pulmonary venous connection to the innominate vein [1]. In this video tutorial, we present the technique of reimplantation of the partial anomalous left superior pulmonary venous connection to the left atrial appendage through a median sternotomy and with a cardioplegic heart. We debate the merits of our strategy with respect to our ultimate goal of achieving long-term patency.
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Venas Pulmonares , Síndrome de Cimitarra , Niño , Humanos , Venas Braquiocefálicas/cirugía , Venas Pulmonares/cirugía , Venas Pulmonares/anomalías , Síndrome de Cimitarra/cirugía , Esternotomía/métodosRESUMEN
BACKGROUND AND AIMS: Epithelioid hemangioendothelioma is a rare malignant vascular tumor with limited literature. AIMS: We reported an innovative endovascular biopsy of the right innominate vein tumor. MATERIALS AND METHODS: Endovascular suction thrombectomy was performed with multipurpose catheter and constant negative pressure under fluoroscopic guidance. RESULTS: Epithelioid hemangioendothelioma was diagnosed preoperatively and a complete margin-free tumor resection with patch repair of the right innominate vein was achieved via sternotomy. DISCUSSION: Preoperatively diagnosis is usually not available due to lesions' location. Identifying malignant vascular tumors becomes valuable to guide the surgical treatment. CONCLUSIONS: In this case report, this innovative endovascular approach led to a rare preoperative diagnosis of EHE and subsequent margin-free resection.
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Hemangioendotelioma Epitelioide , Sarcoma , Adulto , Biopsia , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/patología , Venas Braquiocefálicas/cirugía , Niño , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/patología , Hemangioendotelioma Epitelioide/cirugía , Humanos , Sarcoma/patología , TrombectomíaRESUMEN
BACKGROUND: Multiple complete central venous occlusion (CVO) is rare complication among the hemodialysis population. Percutaneous transluminal angioplasty (PTA) is the recommended treatment for CVO; however, cases with long-segment occlusion remain challenging. CASE DESCRIPTION: We reported a patient who complained of a swollen right arm for 1 month. On admission, his vital signs were within normal limits. The 76-year-old man had been on hemodialysis with a right forearm arteriovenous fistula (AVF) for 4 years with a history of temporizing catheterization and left forearm AVF failure. One year ago, he gradually developed a slight swelling in his right arm and the swelling in his arm was significantly worse one month ago. Digital subtraction angiography (DSA) revealed occlusion in his right innominate vein (IV), proximal subclavian vein (SV), and external and internal jugular veins, as well as stenosis of the ipsilateral cephalic arch and axillary vein (AV). The operation was performed with a pioneered bidirectional approach via ipsilateral superior vena cava (SVC) and AV puncture. The occluded lesions were successfully recanalized, and the patient's symptoms resolved after the operation. The patency of his vascular access was well maintained at the 4-month follow-up. CONCLUSIONS: To the best of our knowledge, this is the first report regarding the application of SVC puncture in PTA for CVO. This technique could be a possible approach when performed by appropriately qualified operators in patients with limited or no other options.