ABSTRACT
Background It is not an uncommon experience for a cardiologist to take a patient with congenital heart disease (CHD) to the catheterization laboratory and spend excessive time to gain vascular access for a diagnostic or interventional procedure. A typical scenario is for the operator to encounter difficulty threading a wire into the femoral vein in spite of excellent blood return from the percutaneous needle. After many attempts, the operator may give up and assume the femoral vein to be occluded. Alternatively, some may inject a small amount of contrast into the needle to evaluate the vein and, if occlusion is discovered, the contralateral femoral vein is attempted. If both veins are occluded or multiple venous access is necessary for a complicated intervention, alternative venous access (jugular, transhepatic, etc.) is used. While alternative venous access is helpful, the direct femoral venous access is best for a majority of cardiac catheterization procedures. Unfortunately, CHD patients who have had multiple cardiac catheterizations or multiple surgeries, especially as an infant, or who have had chronic indwelling lines placed in the femoral vein are the most susceptible to femoral vein occlusions. These same patients are also the ones who require femoral vein access the most. The current chapter will review some techniques to evaluate the occluded femoral vein and recannulize these vessels.
