Patient has a tunneled hemodialysis catheterin her right internal jugular vein.

She has a new (3 wks) PTFE hemodialysis graftin her right upper arm.

Her right arm is now moderately swollen.

Plan: 1. Right central venogram 2. Remove right-side hemodialysis catheter 3. Angioplasty central venous stenosis 4. Insert new left-sided tunneled catheter

Occlusion ofright brachiocephalic vein by

tunneled hemodialysis catheter

Angioplasty (10mm) Post-Angioplasty

Left central veinsare patent

Inserted tunneled catheterinto left internal jugular vein

This stenosis in herright brachiocephalic vein

will need additionalangioplasty and/or stent

However, her currentsymptoms (edema)

should improve so thather new graft can be used