Central Venous Thrombolysis/PTA/Stenting

Central venous stenosis, occlusion, and thrombosis are complications that are being encountered in increasing frequency. These lesions can be directly related to four main causes: neointimal fibro-plasia, trauma, tumor, and mediastinal fibrosis. The clinical situation in which these lesions present and the indications and goals of treatment are quite varied. To better discuss this heterogenous patient population, this article will be separated into two main anatomic divisions: axillary/subclavian veins and superior vena cava/brachiocephalic veins. Management of central venous stenosis and occlusions, while using many of the same approaches and equipment used in the arterial system, is a very different and often frustrating endeavor. Interventional radiologists who enter into the treatment of these lesions must work closely with our medical and surgical colleagues and understand the long-term commitment required to offer optimal care to these patients. Because of many recent technologic advances and relatively poor results of surgical and conservative treatment options, interventional radiologic techniques have evolved into the treatment of choice for many of these lesions.