Recanalization of complex central venous occlusion in a hemodialysis patient with a functioning arteriovenous fistula

The number of individuals undergoing maintenance hemodialysis is rapidly increasing worldwide, accompanied by a rising incidence of central venous stenosis and occlusion, particularly among patients with a history of catheterization. Single-puncture endovascular intervention is generally the preferred treatment approach. We present the case of a 49-year-old male on regular hemodialysis via a functioning right elbow arteriovenous fistula who developed complex stenosis/occlusion involving multiple central venous sites. Due to the challenging venous anatomy and failure of both single- and dual-access techniques, a quadruple-puncture approach was successfully employed to perform balloon angioplasty. This case highlights the value of a personalized and innovative endovascular strategy in managing complex central venous stenosis and occlusion, especially when conventional methods are unsuccessful.