I recently had to refer a patient for a PICC placement by Interventional Radiology who has SVC syndrome (the SVC is occluded below the level of the azygous). The radiologist placed the PICC tip into the azygous vein. After two weeks, we now are having trouble with blood return and have had to Cathflo it twice in one week. I know this tip placement will be problematic and expect issues. Why would a radiologist choose this placement? Should a PICC have even been placed at all? This patient also has abdominal distension and lower leg edema, with warmth, redness and pain. He also has facial swelling and lower hand and arm edema bilaterally. I suggested to the family that they seek a vascular surgeon. The patient has had three failed (occluded) ports in the upper torso and now has a failed port in his right groin. Any words of wisdom for this case? His wife is frustrated, the patient is miserable and their PCP keeps blowing him off.