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Sullivan PM, Ing FF. Systemic Central Venous Rehabilitation in Congenital Heart Disease. Interv Cardiol Clin 2024; 13:439-450. [PMID: 38839176 DOI: 10.1016/j.iccl.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Chronic venous obstructions resulting from indwelling lines, surgery and instrumentation, and congenital anomalies are increasingly common in patients with congenital heart disease (CHD) and other chronic illnesses. Venous obstruction results in threatened long-term vascular access and congestive symptoms. Endovascular therapies are safe and can be effective at rehabilitating obstructed and even occluded veins. The risk of recurrent obstruction is high, however. Post-rehabilitation monitoring and anticoagulation therapy are important, and reinterventions are common. Here, the authors describe techniques to address a variety of venous obstruction lesions that may be encountered in CHD patients and provide illustrative cases.
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Affiliation(s)
- Patrick M Sullivan
- USC Keck School of Medicine, Los Angeles, CA, USA; Children's Hospital Los Angeles Heart Institute, 4650 Sunset Boulevard #34, Los Angeles, CA 90027, USA.
| | - Frank F Ing
- UC Davis School of Medicine, Pediatric Heart Center, UC Davis Children's Hospital, 2516 Stockton Boulevard TICON II, Sacramento, CA 95817, USA
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2
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Moawad S, Vance AZ, Cobb RM, Mantell MP, Cohen R, Clark TWI. Radiofrequency guidewire-facilitated recanalization of chronic thoracic central venous occlusions in hemodialysis patients. CVIR Endovasc 2024; 7:10. [PMID: 38214823 PMCID: PMC10786812 DOI: 10.1186/s42155-023-00422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE To assess the outcome and safety of radiofrequency (RF) wire recanalization in patients with end-stage renal disease (ESRD) and chronic central venous occlusions (CVO). MATERIALS AND METHODS A retrospective review of ESRD patients who underwent RF-wire recanalization of symptomatic chronic thoracic CVO from January 2017 to August 2022 yielded 20 patients who underwent 21 procedures. All patients had undergone at least one prior unsuccessful attempt at central venous recanalization using conventional catheter-based techniques. Technical success was defined by the ability to cross the CVO using RF-wire recanalization enabling endovascular treatment. Access circuit patency was evaluated based on follow-up imaging and symptomatic improvement. RESULTS Radiofrequency wire recanalization was successful in 17/21 procedures (81%) with all patients (100%) reporting resolution of arm ± facial swelling. Three major complications occurred (14%): two hemothoraces and one hemopericardium. Medial stent diameter was 13 mm (range, 9-14 mm). Mean duration of hospital stay was 2 days ± 3 days. Mean procedure time was 158 ± 46 min with a mean fluoroscopy time of 31.7 ± 16.3 min. Primary unassisted patency at 6 and 12 months was 94 ± 6% and 85 ± 10%, respectively. Additional interventions resulted in significantly increased stent graft patency (P = 0.006). CONCLUSION Radiofrequency wire-enabled recanalization of CVO in symptomatic dialysis patients has a high rate of technical success with resolution of arm and facial swelling and resumed use of the ipsilateral dialysis access. Although a superior safety profile was seen than with needle-based techniques such as sharp recanalization, major complications were not infrequent indicating that this RF-wire procedure should be performed in centers equipped to manage central venous perforations.
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Affiliation(s)
- Sherif Moawad
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ansar Z Vance
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ryan M Cobb
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mark P Mantell
- Division of Vascular Surgery, Department of Surgery, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Raphael Cohen
- Division of Nephrology, Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy W I Clark
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Nasser MM, Ghoneim BM, Elmahdy H, Younis S. The outcome of sharp recanalization of chronic central venous occlusions in patients undergoing hemodialysis. J Vasc Surg Venous Lymphat Disord 2024; 12:101692. [PMID: 37797808 DOI: 10.1016/j.jvsv.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/03/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Patients on hemodialysis are particularly vulnerable to central venous occlusion (CVO). Endovascular treatment has gained wide acceptance for the treatment of CVO. However, difficulties in crossing the occluded segment can be encountered during conventional endovascular management. Sharp recanalization has been adopted when conventional endovascular methods could not recanalize the obstructed region. This study aimed to assess the outcome of the sharp venous recanalization technique with angioplasty and stenting in the treatment of CVO in Egyptian patients undergoing hemodialysis. METHODS This retrospective study is based on data from a prospectively maintained department database of patients under regular hemodialysis who underwent the sharp venous recanalization technique for CVO. Routinely, the patients were followed up at 3, 6, and 12 months with a clinical examination. The primary outcomes were technical success and primary patency. Secondary outcomes included complication rates and clinical success. RESULTS This study included 40 patients. Thirty-six patients (90%) achieved technical and clinical success. Seven patients (17.5%) had immediate postoperative complications. Four cases had minor complications (10%) and three patients had major complications (7.5%): hemothorax in two patients (5.1%) and pneumothorax in one patient (2.6%). At the 1-year follow-up, reintervention was required in nine patients (22.5%), with primary patency rate of 77.5% and a secondary patency rate of 100%. CONCLUSIONS Sharp recanalization offers a solution for patients undergoing hemodialysis who developed CVO and failed to be recanalized using the conventional endovascular method. It offered promising technical success, clinical improvement, and good primary patency rates.
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Affiliation(s)
- Mahmoud M Nasser
- Vascular and Endovascular Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Baker M Ghoneim
- Vascular and Endovascular Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Vascular and Endovascular Surgery Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
| | - Hossam Elmahdy
- Vascular and Endovascular Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sayed Younis
- Vascular and Endovascular Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Bai Y, Liang S, Vachharajani TJ, An N, Xu M, Zhou Z, Li H. Feasibility and safety of guidewire-balloon entrapment technique for recanalization of thoracic central vein occlusion in hemodialysis patients. J Vasc Access 2023; 24:1438-1444. [PMID: 35443827 DOI: 10.1177/11297298221092745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the feasibility and safety of Guidewire-Balloon Entrapment Technique (GBET) for the recanalization of thoracic central vein occlusions (TCVOs) in hemodialysis patients. METHODS A retrospective observational study was conducted using data from 28 patients who required the establishment or maintenance of hemodialysis access and were treated with GBET for the recanalization of right-sided TCVOs from January 2017 to April 2021. Of the patients, 27 required tunneled cuffed catheter (TCC) placement or exchange, and 1 had an outflow tract occlusion of the Brescia-Cimino radio cephalic arteriovenous fistula (AVF). RESULTS A total of 26 patients successfully underwent TCC exchange and placement using GBET; 1 patient underwent successful recanalization of an occlusion of the outflow tract of the right Brescia-Cimino AVF; and 1 patient underwent successful TCC placement in the left internal jugular vein (LIJV) after the failure of TCC placement in the right internal jugular vein (RIJV). The success rate for GBET was 27/28 (96.43%), and there were no major complications. CONCLUSION GBET is a safe and effective method for the recanalization of right-sided TCVOs, especially for TCC exchange and placement, and can be used as a safe and easy approach for TCVO recanalization.
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Affiliation(s)
- Yafei Bai
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Shuntian Liang
- Department of Comprehensive Intervention of Southern Medical University of China, Guangzhou, Guangdong, China
| | - Tushar J Vachharajani
- Department of Kidney Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Na An
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Mingzhi Xu
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Zhongxin Zhou
- Department of Comprehensive Intervention of Southern Medical University of China, Guangzhou, Guangdong, China
| | - Hong Li
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, 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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Trivedi SB, Ray C, Chadalavada S, Makramalla A, Kord A. Superior Vena Cava Syndrome: An Update and Literature Review of Percutaneous Endovascular Treatments. Semin Intervent Radiol 2022; 39:446-453. [PMID: 36406024 PMCID: PMC9671675 DOI: 10.1055/s-0042-1757344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Surbhi B. Trivedi
- Division of Interventional Radiology, Department of Radiology, the University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Charles Ray
- Division of Interventional Radiology, Department of Radiology, the University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Seetharam Chadalavada
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Abouelmagd Makramalla
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
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Tabriz DM, Arslan B. Management of Central Venous Stenosis and Occlusion in Dialysis Patients. Semin Intervent Radiol 2022; 39:51-55. [PMID: 35210733 PMCID: PMC8856783 DOI: 10.1055/s-0041-1742152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Central venous occlusions (CVOs) of the major intrathoracic veins (jugular, subclavian, brachiocephalic, superior vena cava) can cause debilitating symptoms, negatively impact arteriovenous fistula/graft function, or limit potential access creation options in end-stage kidney disease (ESKD) utilizing hemodialysis (HD). This review summarizes the incidence, pathophysiology, indications/contraindications, and management options of CVOs in the ESKD on HD population and concludes with considerations and examples when planning endovascular central recanalization procedures, which have risen as the first-line management when appropriate.
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Affiliation(s)
- David M. Tabriz
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Bulent Arslan
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois,Address for correspondence Bulent Arslan, MD, FSIR Department of Vascular and Interventional Radiology, Rush University Medical Center1750 W. Harrison St. (Jelke), Suite 164, Chicago, IL 60612
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8
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Dai R, Kim CY. Blunt Transmediastinal Dissection with Radiofrequency Wire Reentry for Extravascular Bypass of Thoracic Central Venous Occlusions Refractory to Recanalization. J Vasc Interv Radiol 2021; 32:558-561. [PMID: 33485769 DOI: 10.1016/j.jvir.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022] Open
Abstract
Extravascular perforation is a risk of recanalizing chronic central venous occlusions. The authors describe an endovascular technique to bypass venous occlusions using a combination of a hydrophilic guide wire and radiofrequency wire in 7 patients to achieve central venous access to the right atrium without major complications.
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Affiliation(s)
- Rui Dai
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Box 3808, 2301 Erwin Road, Durham, NC 27710
| | - Charles Y Kim
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Box 3808, 2301 Erwin Road, Durham, NC 27710.
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Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach. Cardiovasc Intervent Radiol 2021; 44:784-788. [PMID: 33388871 DOI: 10.1007/s00270-020-02728-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the technical success and safety of a steerable coaxial sharp recanalization technique that utilizes routine needles in patients with refractory thoracic central venous occlusions. MATERIALS AND METHODS This retrospective study was performed on 36-attempted sharp recanalizations in 35 patients (mean age 50 years, 23 male) performed via a supraclavicular approach. In all cases, an 18-gauge trocar needle was custom curved to provide directional control during fluoroscopic triangulation. A 22-gauge Chiba needle was then advanced coaxially across the occlusion. A tractogram was performed to assess for traversal of unintended structures. Procedures were completed by catheter placement, angioplasty, or stenting follow successful recanalizations. RESULTS Sharp recanalization using this steerable coaxial needle technique demonstrated a technical success rate of 94% (34/36). The mean occlusion length was 30 mm (range 3-53 mm). In 11 patients, success was achieved using this technique after failure of other advanced techniques. In five procedures, stent interstices were traversed. Sharp recanalization was the direct cause of one major complication consisting of pleural transgression causing mild hemothorax treated successfully with a stent graft. CONCLUSION The proposed technique is effective and safe for patients who have failed traditional blunt recanalization techniques. LEVEL OF EVIDENCE Level 4, Case Series.
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Yin X, Shen X, Zhou Z, Chen Q, Zhou L, Cui T. Efficacy and safety of recanalization with transseptal needle for chronic total occlusion of the brachiocephalic vein in hemodialysis patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1141. [PMID: 33240990 PMCID: PMC7576017 DOI: 10.21037/atm-20-5369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Whilst there are effective techniques for the recanalization of central venous occlusions, recanalization of chronic total occlusions remains particularly challenging. This study aims to evaluate the safety and efficacy of recanalization using a transseptal needle in chronic total occlusions of the right brachiocephalic vein (RBV) in long-term hemodialysis patients. Methods In this single-center, retrospective study, maintenance hemodialysis patients with chronic total occlusion of the RBV were enrolled between February 2017 to March 2019 from West China Hospital of Sichuan University. Refractory lesions were defined as complete vascular occlusions with failed recanalization using conventional techniques. Occlusions were approached using a transseptal needle to penetrate which offers an alternative strategy with firm support force. Patient data, treatment outcomes and patency rates were collected and analyzed to assess the safety and efficacy of the technique. Results A total of 16 eligible patients were analyzed. The operation was successful in 13 of the 16 patients and the success rate was 81.25% (13/16). Twelve patients underwent percutaneous balloon dilatation and stent implantation after sharp recanalization, whilst one patient underwent balloon dilatation only. We achieved procedural success in 13 patients without surgical complications, and all of the patients were discharged in a stable condition. The primary patency rates at 3, 6 and 12 months after surgery were 100%, 84.6% and 69.2%, respectively. The primary assisted patency rates were 100%, 84.6% and 76.9%, respectively, and the secondary patency rates were 100%, 84.6% and 76.9%, respectively. Conclusions This study demonstrates that recanalization of chronic total occlusions to the RBV using a transseptal needle is a safe and effective method after traditional guide wire and catheter techniques fail. It was also found that additional techniques are needed for recanalization in patients with RBV occlusion combined with proximal stenosis or occlusion of the right subclavian vein.
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Affiliation(s)
- Xi Yin
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.,The Second People's Hospital of Panzhihua, Panzhihua, China
| | - Xi Shen
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongxin Zhou
- Department of Vascular Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Qin Chen
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhou
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianlei Cui
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
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Gill AE, Shivaram GM. Managing systemic venous occlusions in children. CVIR Endovasc 2020; 3:59. [PMID: 32886283 PMCID: PMC7474020 DOI: 10.1186/s42155-020-00150-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
Pediatric venous disease is increasing in incidence in both inpatient and outpatient populations. The widespread use of central venous access devices as well as the rising incidence of thromboembolic events in pediatrics is leading to more systemic venous occlusions in both the central and peripheral veins. This review focuses on the etiology, presentation, workup, and general technical considerations of recanalization as well as procedural complications related to pediatric systemic venous occlusive disease. The potential role for pediatric interventional radiology guided treatments will be discussed in detail.
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Affiliation(s)
- Anne E Gill
- Department of Radiology & Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, 1405 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Giridhar M Shivaram
- Department of Radiology, Division of Interventional Radiology, University of Washington School of Medicine, Seattle, USA
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Pothineni NVK, Chahal CAA, Frankel DS, Garcia FC, Giri J, Cooper JM, Schaller RD. Percutaneous recanalization of superior vena cava occlusions for cardiac implantable electronic device implantation: Tools and techniques. Heart Rhythm 2020; 17:2010-2015. [DOI: 10.1016/j.hrthm.2020.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 11/25/2022]
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Gallieni M, Matoussevitch V, Steinke T, Ebner A, Brunkwall S, Cariati M, Gallo S, Reindl-Schwaighofer R, Sengölge G. Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry. J Vasc Interv Radiol 2020; 31:1654-1660.e1. [PMID: 32951972 DOI: 10.1016/j.jvir.2020.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the device performance and safety for the Surfacer Inside-Out access catheter system in patients with thoracic central venous obstruction (TCVO) requiring central venous access (CVA). MATERIALS AND METHODS Five sites prospectively enrolled 30 patients requiring a tunneled dialysis catheter between February 2017 and September 2018 in the SAVE (Surfacer System to Facilitate Access in Venous Obstructions) registry. Patient demographics, medical history, and type of TCVO were documented at enrollment. Device performance and adverse events were collected during the procedure and upon hospital discharge. Twenty-nine of the 30 patients enrolled required CVA for hemodialysis. Retrospective classification of TCVOs according to SIR reporting standards showed 9 patients (30%) had Type 4 obstructions, 8 (26.7%) had Type 3, 5 (16.7%) had Type 2, and 8 (26.7%) had Type 1 obstruction. RESULTS Central venous catheters (CVCs) were successfully placed in 29 of 30 patients (96.7%). The procedure was discontinued in 1 patient due to vascular anatomical tortuosity. All 29 patients with successful CVC placement achieved adequate catheter patency and tip positioning. There were no device-related adverse events, catheter malposition, or intra- or postprocedural complications. Mean time from device insertion to removal for the 29 patients who successfully completed the procedure was 24 ± 14.9 (range, 6-70) minutes. Mean fluoroscopy time was 6.8 ± 4.5 (range, 2.2-25.5) minutes. CONCLUSIONS The Surfacer Inside-Out procedure provided an alternative option to restore right-sided CVA in patients with TCVO.
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Affiliation(s)
- Maurizio Gallieni
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Vladimir Matoussevitch
- Department of Vascular Surgery, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany.
| | | | | | - Silke Brunkwall
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Maurizio Cariati
- Department of Radiology, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Roman Reindl-Schwaighofer
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Gürkan Sengölge
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
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Razavi MK. Overview of the safety and efficacy of the Surfacer® Inside-Out® Access Catheter System for obtaining central venous access in patients with thoracic central venous obstructions. Expert Rev Med Devices 2020; 17:937-944. [PMID: 32941079 DOI: 10.1080/17434440.2020.1825938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The development of thoracic central venous obstruction (TCVO) leads to narrowing of the vessel lumen which impacts blood flow and the placement of central venous access. The most common cause of TCVO is central venous catheters (CVCs) which can induce intravascular scarring or endoluminal obstruction via thrombus formation. AREAS COVERED The Surfacer® System is used to obtain central venous access (CVA) in patients with TCVO by facilitating catheter insertion via the novel Inside-Out® approach. This review summarizes the results of clinical studies to date with the Surfacer System, focusing on how the procedure is performed, clinical efficacy and safety of the device and patient populations where the device offers substantial clinical benefit. EXPERT OPINION The Surfacer System offers a safe and effective approach to reliably preserve and restore critical upper body vascular access sites. For dialysis patients, the device offers an alternative which avoids placement of dialysis catheters in veins which may impact the ability to achieve maturation of hemodialysis vascular access or in locations which have an increased risk of insertion-related complications or are associated with higher morbidity.
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Farsad K, Narasimhan E, Russell L, Kaufman JA. Transjugular Intrahepatic Portosystemic Shunt Creation Using a Radiofrequency Wire: Prospective Clinical Safety and Feasibility Trial in Cirrhosis. J Vasc Interv Radiol 2020; 31:1401-1407. [PMID: 32792278 DOI: 10.1016/j.jvir.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the safety and feasibility of using a radiofrequency (RF) wire for portosystemic shunt creation. MATERIALS AND METHODS Ten patients undergoing elective creation of a transjugular intrahepatic portosystemic shunt (TIPS) or a direct intrahepatic portosystemic shunt (DIPS) were prospectively enrolled. Primary outcomes were the safety and feasibility of RF wire used for the creation of TIPS and DIPS. Median age was 66.5 ± 6.1 years. Causes of liver disease included alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), hepatitis C virus (n = 1), primary biliary cirrhosis (n = 1), autoimmune hepatitis (n = 1). The median score for model for end-stage liver disease was 11 ± 4.3. The Rosch-Uchida TIPS set was used with intravascular ultrasonography guidance in all cases. A 0.035-inch RF wire was used in lieu of the trocar needle through the 5-F TIPS set catheter to create a track between the hepatic vein and the portal vein. All shunts were created using stent grafts. RESULTS Technical success rate was 100%. In 7 of 10 patients, portal vein access was achieved with a single pass. A DIPS was created in 2 patients based on anatomic favorability. Median fluoroscopy time was 13.3 ± 3.8 min, and median total procedure time was 102 ± 19 min. The wire passed through parenchyma without subjective deflection. There was 1 case of extracapsular puncture with no clinical consequence. The RF wire was too stiff to curve into the main portal vein, requiring wire exchange in all but 1 case. Mean portosystemic gradient decreased from 13.9 ± 3.3 to 5.9 ± 2.1 mm Hg. No immediate complications were encountered. Shunt patency was 100% at 30 days. CONCLUSIONS Creation of TIPS and DIPS using an RF wire was safe and feasible, enabling creation of an intrahepatic track without subjective deflection in cirrhotic patients.
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Affiliation(s)
- Khashayar Farsad
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
| | - Evan Narasimhan
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Lori Russell
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - John A Kaufman
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
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Chopra P, Cleveland CH, Johnson M, Michell H, Holoch P, Irwin B, Scriver GM, Morris CS. Creation of a neoinfundibulum and serial balloon dilations for the treatment of the excluded calyx: Two cases describing a novel technique. Radiol Case Rep 2020; 15:1121-1127. [PMID: 32509047 PMCID: PMC7265071 DOI: 10.1016/j.radcr.2020.04.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/05/2022] Open
Abstract
An excluded calyx is a rare, acquired urologic condition where there is discontinuity between a portion of the renal collecting system with the remainder of the collecting system. Re-establishment of reliable long-term communication between the excluded calyx and the remaining collecting system is crucial for preservation of renal function and possible relief of symptoms. In this manuscript, we discuss two such cases where a previously undescribed novel procedure is used for treatment of this uncommon condition, where percutaneous antegrade transcatheter techniques were used to establish long-term urinary drainage. The first case discusses an excluded calyx in a 17-year-old male who suffered left renal injury after a high speed motor vehicle accident, where the kidney was divided by the injury and subsequently required creation of a neoinfundibulum in order to maintain continuity of the collecting system. The second case involves a 39-year-old female who underwent resection of a renal cell carcinoma, later developing an excluded calyx where radiofrequency wire recanalization was performed and the neoinfundibular track underwent serial retrograde balloon dilation, resulting in a continuous collecting system. Both patients have done well for more than 2 years after neoinfundibulum creation, showing that this novel technique should be considered a viable and safe procedure in the treatment of this rare condition.
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Affiliation(s)
- Prajna Chopra
- University of Vermont College of Medicine, Burlington, VT, USA.,Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA
| | | | - Mark Johnson
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Hans Michell
- University of Vermont College of Medicine, Burlington, VT, USA.,Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA
| | - Peter Holoch
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Brian Irwin
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Geoffrey M Scriver
- University of Vermont College of Medicine, Burlington, VT, USA.,Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA
| | - Christopher S Morris
- University of Vermont College of Medicine, Burlington, VT, USA.,Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA
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Young JL, McLennan G. Thoracic Central Vein Occlusion in the Dialysis Patient: An Interventional Perspective. Adv Chronic Kidney Dis 2020; 27:236-242. [PMID: 32891308 DOI: 10.1053/j.ackd.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 11/11/2022]
Abstract
Thoracic central venous occlusion in hemodialysis patients can cause significant disability from arm and facial swelling and can lead to worsening function of dialysis access. Current techniques for managing thoracic central venous occlusion and some of the newer techniques for achieving dialysis access when all central veins are occluded. Techniques for dealing with acute superior vena cava thrombosis will also be covered as will the complications of central venous recanalization techniques.
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Vachharajani TJ, Kirksey L, McLennan G. Endovascular Bypass for Thoracic Vein Occlusion: An Innovative Technique for Hemodialysis Vascular Access. Am J Kidney Dis 2020; 75:468-470. [PMID: 32046863 DOI: 10.1053/j.ajkd.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Tushar J Vachharajani
- Glickman Urological & Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic Foundation, Cleveland, OH.
| | - Lee Kirksey
- Heart and Vascular Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic Foundation, Cleveland, OH
| | - Gordon McLennan
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic Foundation, Cleveland, OH; Section of Vascular and Interventional Radiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic Foundation, Cleveland, OH
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Transjugular Intrahepatic Portosystemic Shunt Creation Using a Radiofrequency Wire: Acute Feasibility Study in Swine. J Vasc Interv Radiol 2019; 31:682-685. [PMID: 31690521 DOI: 10.1016/j.jvir.2019.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022] Open
Abstract
The feasibility of a radiofrequency (RF) wire to replace the needle trocar for the creation of a transjugular intrahepatic portosystemic shunt (TIPS) was assessed in 3 swine by using fluoroscopy and intravascular ultrasonography (IVUS). RF wire passes were successful from hepatic to portal vein and from inferior vena cava to portal vein. Technical success was achieved using both IVUS guidance and carbon dioxide portography. The wire tracked a straight course under RF energy application without subjective deflection and, when centrally advanced, served as the working wire for completing the TIPS in 2 attempts with stent graft deployment. No procedural adverse events from the use of RF wire were observed.
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