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Ma X, Peng N, Wang L, Xia Y. Regarding "Management of Central Venous Stenoses and Occlusions". Cardiovasc Intervent Radiol 2023; 46:1765-1766. [PMID: 37978063 DOI: 10.1007/s00270-023-03603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Xiao Ma
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Na Peng
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Lei Wang
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Yaoxiong Xia
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China.
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Kitrou P, Katsanos K, Karnabatidis D. Management of Central Venous Stenoses and Occlusions. Cardiovasc Intervent Radiol 2023; 46:1182-1191. [PMID: 37460644 PMCID: PMC10471665 DOI: 10.1007/s00270-023-03461-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/01/2023] [Indexed: 09/02/2023]
Abstract
Symptomatic central venous stenosis and occlusion remains the gordian knot of vascular access. Advances in techniques, like sharp recanalization, allowed for improved success rates in crossing these difficult lesions. There is also increasing evidence of new devices in treating central venous stenosis and, at the same time, improving the time needed between interventions. High-pressure balloons, paclitaxel-coated balloons, bare metal stents and covered stents have been tested with an aim to offer additional treatment options, although obstacles still exist. In the current review, authors describe relevant techniques and options, provide the evidence and evaluate the actual implementation of these devices in this demanding field.
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Affiliation(s)
- Panagiotis Kitrou
- Interventional Radiology, Patras University Hospital, Patras, Greece.
- Medical School, University of Patras, Patras, Greece.
| | - Konstantinos Katsanos
- Interventional Radiology, Patras University Hospital, Patras, Greece
- Medical School, University of Patras, Patras, Greece
| | - Dimitrios Karnabatidis
- Interventional Radiology, Patras University Hospital, Patras, Greece
- Medical School, University of Patras, Patras, Greece
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Chen B, Lin R, Dai H, Tang K, Zhang G, Yang J, Xiang X, Huang Y. XperCT facilitates sharp recanalization for the treatment of chronic thoracic venous occlusive disease in hemodialysis patients. J Vasc Access 2023:11297298231151459. [PMID: 36708010 DOI: 10.1177/11297298231151459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Our objective was to evaluate the feasibility of XperCT combined fluoroscopy to guide sharp recanalization for the treatment of chronic thoracic venous occlusive disease in hemodialysis patients. METHODS The records of hemodialysis patients with chronic thoracic venous occlusive disease who received endovascular sharp recanalization after conventional techniques failed were retrospectively reviewed. The sharp devices used for recanalization included the stiff end of a guidewire, Chiba biopsy needle, RUPS-100 set, and transseptal needle. The needle was advanced toward a target placed at the opposite end of the occlusion and was guided by fluoroscopy and/or XperCT. While the guidewire crossed the occlusion, endovascular procedures such as percutaneous angioplasty were performed for the treatment of the occlusion. RESULTS The analysis included 32 sharp thoracic vein recanalization procedures in 29 patients. Two attempts in one patient failed, and in one patient the first attempt failed but the second attempt was successful. In one patient, two separate successful procedures were performed, and the other 26 procedures in 26 patients were successful. The overall technical success rate of sharp recanalization was 90%. The mean number of puncture attempts in the combined group was less than that of the fluoroscopy-guided alone group (2 vs 5, p < 0.05). The success rate of sharp recanalization in the combined group was higher (100% vs 86%), and the recanalization time (28.5 min vs 36 min, p > 0.05) was no different. There was no statistical difference in procedure-related complications between the groups. CONCLUSION XperCT can facilitate sharp recanalization for the treatment of chronic thoracic venous occlusive disease in hemodialysis patients.
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Affiliation(s)
- Bin Chen
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Run Lin
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haitao Dai
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Keyu Tang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guiyuan Zhang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianyong Yang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianhong Xiang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonghui Huang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Sweeney AM, Makary MS, Greenberg C, Chick JFB, Abad-Santos M, Monroe EJ, Ingraham CR, Vaidya S, Bertino FJ, Johnson E, Shin DS. Percutaneous thrombectomy of upper extremity and thoracic central veins using Inari ClotTriever System: Experience in 14 patients. J Vasc Surg Cases Innov Tech 2023; 9:101096. [PMID: 36852320 PMCID: PMC9958069 DOI: 10.1016/j.jvscit.2023.101096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
Objective In the present report, we have described the technical and clinical outcomes of percutaneous thrombectomy in the deep veins of the upper extremity and thorax using the ClotTriever system (Inari Medical, Irvine, CA). Methods Fourteen patients with symptomatic deep venous occlusive disease in the upper extremity deep veins and thoracic central veins who had undergone thrombectomy using the ClotTriever system between October 2020 and January 2022 were reviewed. The technical results, adverse events, imaging follow-up data, and clinical outcomes were recorded. Results Fourteen patients (seven men and seven women; mean age, 53.6 ± 13.3 years) constituted the study cohort. Of the 14 patients, 9 (64.3%) had had DVT due to intravascular invasion or external compression from known malignancy, 2 (14.3%) had had infected thrombi and/or vegetation due to Staphylococcus aureus refractory to intravenous antibiotic therapy, and 3 (21.4%) had had a benign etiology for thrombus formation. The presenting symptoms included upper extremity and/or facial swelling (n = 14), upper extremity pain (n = 6), fever (n = 2), and dyspnea (n = 1). Thrombectomy with the ClotTriever system was successfully completed in all 14 patients. Seven patients (50.0%) had required additional venous stent reconstruction after thrombectomy to address the underlying stenosis. No major adverse events were noted. All the patients had experienced resolution of the presenting symptoms. Conclusions For the management of symptomatic deep venous occlusive disease of the upper extremity deep veins and thoracic central veins, thrombectomy using the ClotTriever system was feasible with excellent technical and clinical success.
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Affiliation(s)
- Ashley M. Sweeney
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Colvin Greenberg
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | | | - Matthew Abad-Santos
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Eric J. Monroe
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, Madison, WI
| | - Christopher R. Ingraham
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Sandeep Vaidya
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | | | - Evan Johnson
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - David S. Shin
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA,Correspondence: David S. Shin, MD, Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific St, Seattle, WA 98195
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Shin DS, Jackson TR, Bertino FJ, Monroe EJ, Hage AN, Lee E, Ingraham CR, Vaidya S, Chick JFB. Kissing Viabahn VBX stent graft reconstruction of thoracic central veins for management of superior vena cava syndrome. J Vasc Surg Venous Lymphat Disord 2022; 10:1279-1287.e1. [PMID: 35843595 DOI: 10.1016/j.jvsv.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In the present study, we evaluated the technical and clinical outcomes of thoracic central vein reconstruction for superior vena cava (SVC) syndrome using kissing Viabahn VBX stent grafts (W.L. Gore & Associates, Flagstaff, AZ). METHODS All adult patients with SVC syndrome who had undergone attempted bilateral brachiocephalic vein-to-SVC reconstruction using kissing VBX stent grafts at an academic hospital between August 2019 and February 2021 were reviewed. The technical results, adverse events, imaging follow-up findings, and clinical outcomes were recorded. Patency over time was assessed using Kaplan-Meier analysis. RESULTS A total of 28 patients (16 women and 12 men; mean age, 52.0 years) constituted the study cohort. Of the 28 patients, 17 (60.7%) had had benign and 11 (39.3%) malignant etiologies. The presenting symptoms included neck swelling (n = 17; 60.7%), bilateral upper extremity swelling (n = 15; 53.6%), dyspnea (n = 7; 25%), unilateral upper extremity swelling (n = 4; 14.3%), and dysphagia (n = 1; 3.6%). SVC reconstruction with VBX stent grafts in a kissing configuration was successfully completed in 27 of the 28 patients (96.4%). Four major adverse events were noted in the benign etiology subgroup (23.5%), including intraprocedural hemopericardium (n = 3) and delayed pneumothorax (n = 1). Of the 28 patients, 27 (96.4%) had experienced resolution of their presenting symptoms. The mean clinical follow-up for the living patients was 358.8 ± 77.2 days (range, 78-645 days). The mean imaging follow-up for the living patients was 272.6 ± 91 days (range, 26-594 days). The primary, primary-assisted, and secondary patency rates at 12 months were 71.8%, 88.8%, and 100%, respectively. CONCLUSIONS For the management of SVC syndrome, thoracic central vein reconstruction with kissing VBX stent grafts was feasible with a high rate of symptom resolution and acceptable patency. However, this technique should not be recommended for those with benign SVC syndrome owing to the high risk of cardiac tamponade.
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Affiliation(s)
- David S Shin
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA; The Deep Vein Institute, University of Washington, Seattle, WA.
| | - Tyler R Jackson
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Frederic J Bertino
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Eric J Monroe
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, Madison, WI
| | - Anthony N Hage
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Eunjee Lee
- Department of Information and Statistics, Chungnam National University, Daejeon, South Korea
| | - Christopher R Ingraham
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Sandeep Vaidya
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Jeffrey Forris Beecham Chick
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA; The Deep Vein Institute, University of Washington, Seattle, WA
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