With the widespread adoption of ultrasound-guided (USG) techniques, the traditional landmark-guided infraclavicular approach for central venous cannulation has declined in use. The subclavian vein offers distinct advantages, and there are circumstances where central venous catheter insertion into the subclavian vein (SCV) is necessary, particularly when access to the internal jugular vein is difficult. When the conventional method is challenging, alternative strategies for SCV cannulation are required. This review examines current concepts and available evidence regarding USG supraclavicular brachiocephalic vein (SC-BCV) and infraclavicular axillary vein (IC-AXV) cannulation as practical alternatives for central venous access. USG SC-BCV cannulation has several advantages, including a shorter distance to the target vein, a more direct catheter trajectory to the superior vena cava, and reduced risks of pneumothorax and arterial puncture. Comparative studies and meta-analyses demonstrate higher first-attempt success rates and lower malposition rates compared with landmark-guided IC-SCV cannulation. USG IC-AXV cannulation is also increasingly recognized as a safe and effective option, particularly useful in patients with tracheostomy, chest wall injuries, or infection risks near conventional sites. Evidence suggests that success rates are comparable to those of internal jugular vein (IJV) cannulation, with fewer infectious complications in selected patients. Both SC-BCV and IC-AXV approaches require proficiency with long-axis imaging and precise needle tracking but can be mastered with training. Accumulating evidence supports USG SC-BCV and IC-AXV cannulation as reliable alternatives to both landmark-guided IC-SCV and USG IJV approaches.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective resuscitative modality to temporize noncompressible truncal hemorrhage. Confirming the proper position of the balloon catheter in the target aortic zone is vital. Currently, there is a need for nonradiographical methods. This would overcome the drawbacks of conventional imaging modalities, such as fluoroscopy. Several studies have suggested ultrasound-guided visualization via subxiphoid, transperitoneal, or transesophageal views as an alternative to conventional imaging methods. However, such views are easily obscured in emergency settings. Herein, we report the case of a 70-year-old patient who was successfully resuscitated by REBOA under the guidance of transsplenic ultrasound. REBOA was safely performed using transsplenic visualization without fluoroscopy.