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Chronic indwelling catheters are plagued with a high rate of complications, including infection, central venous occlusion, or thrombosis. When direct access to the superior or inferior vena cava is not possible, venography may identify alternatives that might be viable with current endovascular techniques. This case report describes the successful placement of a tunneled catheter for total parenteral nutrition in the azygos arch through a small collateral vein from the left jugular vein in a patient with no other alternatives because of superior vena cava occlusion and inferior vena cava thrombophlebitis.

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aortic aneurysm repair. Our institution has utilized the superficial femoral artery (SFA) as our access of choice for EVAR (not randomized). Our objective was to analyze all EVARs to assess if type of access or artery produced preferential results intra-and postoperatively. Patient populations reviewed were percutaneous EVAR (PEVAR), SFA cut-down, and CFA cut-down.Methods: EVAR procedures at our institution from 2004 to 2014 were retrospectively reviewed for blood loss, transfusions, access location, accessed artery, follow-up imaging, length of stay (LOS), patency, 30-day mortality, and wound infection rates. Data were analyzed using two-tailed unpaired Student t-test.Results: A total of 484 EVAR procedures identified (73 PEVAR, 337 SFA cut-down, 74 CFA cut-down) with a distribution of 4.6% thoracic and 95.4% abdominal. Overall EVAR 30-day mortality was 0.39%. All 30-day wound infections (2.96% of all EVAR) were in cut-down access patients (0 PEVAR, 1 SFA, 1 CFA). Fifteen 30-day wound infections were found in cut-down patients (3.86% SFA; 2.70% CFA) and none in PEVARs, but this was not statistically significant (P > .05). SFA cut-down resulted in the least blood loss (median, 96.44 mL; P < .05), followed by PEVAR and CFA cut-down (233.82 mL and 291.67 mL, respectively; P < .5). There was no significant difference in transfusion rates (P > .05). Conversion rates for PEVARs were 17% in SFA accessed and 16% in CFA. The percutaneous approach did have a reduction in LOS from procedure date to discharge (P < .05). All but one patient maintained patency at latest follow-up imaging (mean, 30.0 months).Conclusions: EVAR procedures utilizing the cut-down approach may benefit from utilizing the SFA in terms of blood loss and LOS. PEVAR resulted in significantly less postoperative hospital days, and, while PEVAR did result in less wound infections, this was not statistically significant. Further studies will be needed.

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