EXAMINATION: Central Venogram
CLINICAL HISTORY:
IV access requested. Central venous angiogram performed due to central venous occlusion.
FINDINGS:
Under ultrasound guidance, access was obtained into the basilic vein. Subsequently, under DSA
imaging left arm and central venous angiogram was performed.
Images demonstrate mature collaterals in the region of the distal subclavian vein extending into the neck
and along the chest wall. The collateral veins to communicate to the superior vena cava.
A 0.018 inch wire was threaded through the collateral veins into the superior vena cava. This wire was
utilized to advance the PICC line to the superior vena cava.
IMPRESSION:
THIS COMPLETE OCCLUSION OF THE CENTRAL VENOUS SYSTEM LEVEL OF THE MID TO
DISTAL RIGHT SUBCLAVIAN VEIN.
THERE ARE NUMEROUS COLLATERAL VEINS EXTENDING INTO THE NECK AND CHEST WHICH
DO COMMUNICATE TO THE SUPERIOR VENA CAVA. THE COLLATERAL WAS UTILIZED TO GAIN
ACCESS TO THE SUPERIOR VENA CAVA WHICH WAS SUBSEQUENTLY USED FOR PICC LINE
PLACEMENT.