Computed Tomography-guided Sharp Needle Venous Recanalization of Chronic Clot

This article outlines a case performed at our institution that involved direct sharp recanalization of the superior vena cava (SVC) as a way to bypass chronic venous thrombus using a combination of ultrasound and computed tomography (CT) guidance. The case is of a patient requiring a Denver shunt for chronic chylous ascites. His prior shunts placed in the right internal jugular and subclavian veins became thrombosed repeatedly. His left subclavian vein was resected with subsequent occlusion of the graft. The brachiocephalic vein was narrowed likely after his mediastinal lymph node dissection. Revision of the Denver shunt could therefore only be done by directly cannulating into the proximal SVC away from the thrombosed right internal jugular vein. This case outlines the use of CT as an adjunct to standard ultrasound or fluoroscopic guided sharp needle recanalization which has not previously been described in the literature and offers clinicians an additional tool to help treat long-segment thrombus and preserve important vessels for venous access.