**2.2 So what is the basis of puncturing thrombosed veins to be able to pass with a catheter?**

The rationale is that veins, especially those recently occluded and therefore thrombosed, at some point have loose tissues, enough to pass with a wire guide, which can be helped with catheters or dilators.

The recent occlusion of the vein in arteriovenous fistulas in repair surgeries is shown. Through the small hole or loose tissue, seen in the images, the passage can be opened to advance a guide wire and then a catheter when a thrombosed vein is punctured (**Figures 5**–**8**).

All manoeuvres must be done carefully.

In order to move forward, you have to take the time that is necessary.

It is recommended that surgeons do this procedure, because if there is any complication at the moment that requires surgery, it can be solved by the operator himself.

**Figure 5.** *Recently occluded basilica vein; in AVF repair; you can see that there is a small hole.*

#### **Figure 6.**

*Recently occluded femoral vein; in AVF repair; you can see that there is a small hole.*

**Figure 7.** *Recently occluded axillary vein; in AVF repair; you can see that there is a small hole.*

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

#### **Figure 8.**

*Recently occluded axillary vein; in AVF repair; you can see that there is a small hole.*

Or in case you need open surgery to pass the catheter, a surgeon's help is required.
