The arm venogram allways ovewrestimates the degree of obstuction mpshi WITH Audio 12Oct17 скачать в хорошем качестве

The arm venogram allways ovewrestimates the degree of obstuction mpshi WITH Audio 12Oct17

The axillary vein venogram always overestimates the severity of obstruction in a patient with existing leads. My recommendation is to enter the vein peripheral to the occlusion while contrast is flowing, insert a small catheter up to the side of obstruction to determine if there is an opening and where to advance the wire. As you'll see on subsequent videos even when the vein appears to be totally occluded it is often possible to advance a wire through the occlusion and perform venoplasty for access. This technique saves the need for going to the other side as well as reducing the need for and expense of extraction for access. In my opinion subclavian venoplasty is something that all implanting physicians should be trained to do and be comfortable with given the demonstrated safety, benefits provided to the patient and the cost reduction.