Highlights Recurrent central venous access can lead to central venous occlusions. Collateral flow can be used adventitiously for PICC tip placement. Sharp recanalization can be used to reconstitute patency of an occluded SVC.

Venous bullet embolism is a rare complication of trauma. We describe a patient who sustained a gunshot wound. Computed tomography revealed antegrade embolization of the bullet to the right hepatic vein (RHV). The risk of not retrieving the bullet embolus and subsequent embolization to the pulmonary circulation includes pulmonary artery thrombosis, bleeding, or abscess formation. The bullet was retrieved through right internal jugular vein access; assisted by percutaneous transhepatic repositioning and endovascular balloon-immobilization of the bullet. The balloon served to "isolate" the bullet within the RHV to avoid the risk of endovascular migration to the pulmonary circulation. Transhepatic access allowed repositioning of the bullet within the RHV leading to successful snare retrieval. This technique demonstrates advantages of percutaneous and endovascular accesses, that repositioned and immobilized the bullet in the RHV to accomplish controlled endovascular retrieval.

In this report, we describe a case of deep vein thrombosis with suspected congenital inferior vena cava atresia treated with thrombolysis, angioplasty, and bilateral “kissing” iliac stent placement. An 18-year-old male presented with left common iliac vein thrombus and suspected congenital inferior vena cava atresia. He was treated over 4 days and discharged on anticoagulation which was continued long-term. These treatments were shown to be clinically successful in treating and preventing re-thrombosis in the context of inferior vena cava atresia initially presenting with symptomatic bilateral lower extremity deep vein thrombosis.

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