Endovascular strategy for recanalization of long-segment central vein occlusion with concomitant arteriovenous fistula creation.

Recanalization of long-segment central vein flush occlusion in hemodialysis patients has been advocated in lieu of central vein bypass and thoracotomy to restore arteriovenous access availability. We report a challenging case of complex central venous flush occlusion in a 50-year-old woman on hemodialysis who presented with right arm and facial swelling. A concise step-by-step description of endovascular strategy with retrograde and antegrade balloon angioplasty techniques for central vein recanalization with concomitant arteriovenous fistula creation is provided.