Fig. 2

67-year old male on hemodialysis with multiple failed prior access sites and a poorly functioning left transposed brachiobasilic fistula with high venous pressures. He has a chronic left axillosubclavian vein occlusion, secondary to a bare nitinol stent placed within the cephalic arch at an outside facility at the time of a previously functioning brachiocephalic fistula which has since been abandoned. A Initial IR clinic visit showing left arm swelling and hyperpigmentation from chronic venous hypertension. B Initial venogram performed through the left brachiobasilic fistula showing chronic occlusion of the axillary vein at the site of the prior cephalic arch stent (arrow) with mediastinal collaterals reconstituting the left brachiocephalic vein (arrowheads). C Fluoroscopic view after traversal of PowerWire (tip shown with arrow) across the occlusion into the snare in the left subclavian vein. D Capture of the PowerWire with the snare. E Initial balloon dilation of the axillosubclavian occlusion with an 8 mm ultrahigh pressure balloon (Conquest, Becton Dickinson, Franklin Lakes, NJ). F Completion venogram following serial balloon dilation to 10 mm, deployment of a 10 mm × 100 mm PTFE-lined stent graft (Viabahn) and 10 mm venoplasty. G IR clinic visit at 4 weeks showing complete resolution of arm swelling