Procedural Technique:
The procedure was performed, under general anesthesia in the
electrophysiology lab. A left arm venogram was performed, which
demonstrated total occlusion of the left subclavian vein with collateral
formation (Figure: 1).
- The left axillary vein was cannulated using a 21-gauge micro puncture
needle distal to the occlusion
- A 0.018 - inch micro-puncture wire was advanced to the left subclavian
vein. The micro-puncture wire was unsuccessful in crossing the
occlusion so further advanced techniques (4) were applied to cross the
lesion
- After crossing the lesion, subclavian fibroplasty was performed using
a 4-mm non-compliant balloon from the superior vena cava-right atrium
junction to the device pocket
- Multiple sites of severe stenosis of the left subclavian vein were
noted
- After pre-dilatation, a PCB (7 X 40 mm) was advanced to the site of
initial total occlusion and the balloon was inflated for 30 seconds.
- The balloon was withdrawn & hemostasis achieved