**2. Implant a catheter through a thrombosed vein**

I recommend that these practices be done by a surgeon who often performs haemodialysis accesses, or by an operator in conjunction with a surgeon, so that if a complication occurs he/she can resolve it or use a different tactic.

There must be an operating room equipped with an echo doppler equipment, good quality fluoroscopy, specialised human resources, a variety of guide wires, catheters, dilators, and a complete set of cardiovascular surgery [7] (**Figure 1**).

Given this situation and the fact that the patient is young, I implant catheters through any of the veins mentioned above, either because they have a central occlusion or because they are directly thrombosed throughout their entire course. Often I have been able to implant catheters in those with recent occlusion (**Figures 2**–**4**).

#### **Figure 1.**

*Operating room, equipped with doppler echo, fluoroscopy, surgical fields, surgeon's assistants, complete surgical instruments.*

*Occluded vein, with long stenosis, dissected for the repair of an arteriovenous fistula for haemodialysis.*

*Exhaustion of Vascular Accesses for Haemodialysis: Access by Thrombosed Vein DOI: http://dx.doi.org/10.5772/intechopen.101198*

#### **Figure 3.**

*Old occlusion of the superior vena cava with a stent also occluded, a guidewire, catheter and stent can be seen; it was not possible to pass; in this case, the femoral vein with recent occlusion is accessed.*

#### **Figure 4.**

*This case of recent occlusion of the innominate vein and left subclavian could be passed. The right side shows abundant collateral venous circulation for a long-time occlusion.*

Occluded veins with a long time of evolution is usually fibrosed and it is difficult or impossible to cross with the guide wire.
