Small needle puncture of a central venous occlusion in a hemodialysis patient that could not be traversed by a conventional technique.

A 75-year-old woman with hemodialysis-related right subclavian vein occlusion was referred to our hospital for retry of endovascular treatment. The occluded segment could not be crossed via either antegrade or retrograde approaches, including puncturing the obstruction with the stiff end of the guide wire. The obstruction was successfully punctured using a 75-cm long 21-G needle via the right median cubital vein and a metallic stent was placed to cover the occluded segment after balloon angioplasty. The recanalized segment was patent for 10 months until the patient's death from concomitant disease.