• Pierre Yves Marcy, Mostafa El Hajjam, Alexis Lacout, Caroline Nöel, Jean Jacques Simon, and Andrea Figl.
• François Baclesse Cancer Research Institute, Caen Cedex - France.
• J Vasc Access. 2013 Oct 1;14(4):388-91.

PurposeTo report the cross-over venous catheter technique in case of left-sided central venous (internal jugular, subclavian and innominate veins) occlusion and right-sided central vein patency.MethodsA 60-year-old right breast cancer patient presented with a local recurrence requiring chemotherapy. He presented with a left-sided catheter-related central venous occlusion and radiodermatitis of the right chest and neck. The nonsymptomatic side of insertion was defined as the patient's left side. Successful percutaneous left-to-right external jugular vein (EJV) cross-over access tips and tricks are reported. They include performing (a) the EJV access at the lower neck, (b) the 0.032 hydrophilic guidewire (GW) catheterization of the venous curves, (c) the GW anchor technique into the inferior vena cava, (d) the GW + Glidecath catheter stiffening technique and (e) the over-the-stiff wire implantable catheter push.ResultsThe cross-over technique was successful by using real-time ultrasonography/X-ray monitoring and interventional radiology tools (hydrophilic 0.032 in. and stiff 0.0035 in. GW and "J-shaped" Glidecath catheter) and the five-step technique.ConclusionsIn case of left innominate vein occlusion and necessity of left neck venous access, percutaneous EJV access should be attempted under real-time ultrasound/X-ray monitoring when other standard (subclavian venous port and internal jugular vein) routes are no longer available.

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