28 year old female patient with CKD requiring dialysis through a right upper extremity AV fistula. She presents with right upper extremity swelling.
Comment: This chronic occlusion was recanalized using the PowerWire RF Guidewire (Baylis Medical). Access was gained from the internal jugular vein as well as the common femoral vein in order to the potential for relatively straight line passage of the PowerWire. Once access was achieved via all of these veins, a snare was positioned in the SVC and the PowerWire was introduced via the right internal jugular vein. Passage of the wire was found to be extravascular in this case, so covered stents were used to cover the area of occlusion in the proximal subclavian vein extending into the brachiocephalic vein and the upper SVC.