Central venous access with occlusive superior central venous thrombosis

Thrombotic occlusion of the entire superior central venous system is a rare complication of central venous catheterization. Three patients are presented with complete occlusion of the superior vena cava secondary to prolonged central venous catheterization. Thrombotic occlusion of the superior vena cava precludes central venous access by conventional techniques. Thoracotomy with direct catheterization of the right atrium and inferior vena cava cannulation represent alternative approaches but may be associated with significant morbidity. The present report describes a unique combined angiographic/operative technique designed to obtain central venous access with low morbidity in patients with occlusive thrombosis of the superior central venous system.