SVC Syndrome with Baylis RF Recanalization.
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40 y-o female with 8 yr history of ESRD after multiple bilateral tunneled dialysis catheters. She had a Left Brachio-cephalic fistula placed and developed both Left arm swelling with pitting edema and facial/palpebral swelling. Diagnosic fistulagraphy confirmed chest wall collaterals consistent with central outflow obstruction and SVC syndrome.
A snare catheter (wire loop) is placed via the groin up to the medial or central aspect of the obstruction. A RF Baylis wire is used to cross the blockage from the dialysis access site and it is captured via the loop-snare so that the wire is completely through the patient from arm to groin.
Once the wire is passed through the blockage high-pressure balloon angioplasty and stenting are performed to maintain this recanalized vein segment.
Left arm fistulagraphy demonstrating central outflow obstruction with collaterals flowing up the neck causing venous congestion and swelling. Chest wall collaterals were also noted which lead to breast engorgement.
Follow-up SVC and fistulagram demonstrating wide in-line patency and resolution of collaterals after successful recanalization.