Unconventional venous access

Venous access is commonly thought of as the bread and butter of interventional radiologic procedures. However, in those patients who have undergone multiple previous central venous catheter placements, venous access can be a technical challenge for even the most seasoned interventional radiologist. Conventional access sites include the internal jugular veins (IJV) and subclavian veins (SCV). The former should be considered as the primary access site for all patients who will be catheter dependent for whatever reason. Before utilization of the SCV, the external jugular veins (EJV) should be used, especially in the dialysis population. Only after surgical hemodialysis access is no longer an option in the upper extremity should cannulation of the SCV be entertained. Once these usual access sites are no longer available, it may necessary to use an unconventional access method, including catheterization of the common femoral vein, catheterization of enlarged collateral vessels, recanalization of occluded veins, translumbar inferior vena cava (IVC) catheter placement, and transhepatic catheter placement. This chapter serves as a review of these techniques.