Abstract：
Mispositioning in the azygos vein is a rare but hazardous complication of central venous catheterization. A patient was admitted for a dysfunctional hemodialysis tunneled cuffed catheter (TCC) placed in the azygos vein for 4 years. Computed tomography angiography revealed multiple sites of occlusion, including the superior vena cava (SVC), right and left innominate veins (IVs), and right femoral vein. Percutaneous transluminal angioplasty and a TCC replacement based on a segment-by-segment recanalizing strategy were performed. First, an 8-Fr sheath was inserted through the left femoral vein approach to retrogradely traverse the occlusive SVC followed by a guidewire extending to the occlusive left IV. A left transjugular 15-cm snare was inserted to capture the transfemoral guidewire and achieve recanalization from the left IV to the SVC. Second, a transjugular guidewire was advanced through the dysfunctional TCC yet shunted into the left IV due to the inability to cross the SVC. A left transfemoral 15-cm snare was inserted to capture the guidewire and achieve complete recanalization from the right internal jugular vein to the SVC. Balloons were passed over the guidewires to dilate the obstructive lesions sequentially, and a new TCC was inserted successfully with the tip positioned in the right atrium.
摘要：
奇静脉中的错位是中心静脉导管插入术的罕见但危险的并发症。一名患者因功能失调的血液透析隧道袖口导管（TCC）放置在奇静脉中4年而入院。计算机断层扫描血管造影显示多个闭塞部位，包括上腔静脉（SVC），左右无名静脉（IV），和右股静脉.进行了基于逐段再通策略的经皮腔内血管成形术和TCC置换。首先,通过左股静脉入路插入8-Fr鞘，以逆行穿过闭塞的SVC，然后通过导丝延伸至闭塞的左IV。插入左经颈静脉15厘米的圈套器，以捕获经股引导线，并实现从左IV到SVC的再通。第二,经颈静脉导丝通过功能失调的TCC前进，但由于无法穿过SVC而分流到左IV。插入左侧经股15厘米的圈套器以捕获导丝并实现从右颈内静脉到SVC的完全再通。球囊通过导丝依次扩张阻塞性病变，并成功插入新的TCC，尖端位于右心房。
