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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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2
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Liu C, Sun J, Xiao L, Cui T. The guidewire of the transhepatic vein as a target of superior vena cava puncture in a hemodialysis patient. Asian J Surg 2023; 46:4909-4910. [PMID: 37330296 DOI: 10.1016/j.asjsur.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023] Open
Affiliation(s)
- Chuanwen Liu
- Department of Nephrology, The Second People's Hospital of Deyang City, Deyang, China
| | - Jibo Sun
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Xiao
- 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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Tanaka M, Dai R, Randhawa A, Smolinski-Zhao S, Wu V, Walker TG, Daye D. Catheter Directed Thrombectomy and Other Deep Venous Interventions in Cancer Patients. Tech Vasc Interv Radiol 2023; 26:100900. [PMID: 37865450 DOI: 10.1016/j.tvir.2023.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Treating cancer patients with deep venous thrombosis/venous thromboembolism (DVT/VTE) can be challenging as patients are frequently unable to receive the standard therapy of anticoagulation due to the increased risk of bleeding complications seen in this population. Similarly, the hesitation of interventionalists to use thrombolytic agents due to bleeding risks limits percutaneous intervention options as well. Further, outcome data and guidelines do not exist for oncologic patients and often treatment is tailored to patient-specific factors after multidisciplinary discussion. This article reviews specific factors to consider when planning percutaneous treatment of cancer patients with DVT/VTE, focusing on the iliocaval system.
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Affiliation(s)
- Mari Tanaka
- Department of Radiology - Interventional Radiology, Massachusetts General Hospital, Boston, MA
| | - Rui Dai
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Animan Randhawa
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | | - Vincent Wu
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - T Gregory Walker
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, Boston, MA.
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Wen C, Chen B, Lin R, Dai H, Tang K, Zhang G, Huang J, Liao C, Zeng L, Xiang X, Yang J, Huang Y. Clinical Implications of Phenotypes of Hemodialysis Patients With Central Venous Occlusion or Central Venous Stenosis Defined by Cluster Analysis. Front Cardiovasc Med 2022; 9:901237. [PMID: 35795365 PMCID: PMC9251183 DOI: 10.3389/fcvm.2022.901237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to investigate the association between clinical factors of patients with central (superior vena cava, brachiocephalic, or subclavian) venous occlusion or central venous stenosis (CVO/CVS) and the difficulty of interventional recanalization as well as the duration of postoperative patency. Methods A total of 103 hemodialysis patients with CVO/CVS treated with endovascular treatment were enrolled. The two-step cluster analysis was selected to differentiate the cases into distinct phenotypes automatically. Differences in characteristics, the difficulty of interventional recanalization, and the duration of postoperative primary patency time between the two clusters were statistically compared. Results The 103 cases were divided into distinct two clusters by the two-step cluster analysis with 48 (46.6%) in cluster 1 and 55 (53.4%) in cluster 2. Compared to cluster 2, patients in cluster 1 have a higher proportion of blunt stump, side branches, occlusion lesions >2 cm, calcification, or organization. Moreover, the above four factors were, in turn, the most critical four predictors distinguishing 103 patients into two clusters. The remaining six factors were, in turn, occlusion located in the superior vena cava (SVC), duration of central venous catheterization (CVC), lesion location, vessel diameter, number of CVC, and previously failed lesion. Of the four most important factors, with the exception of occlusion lesions exceeding 2 cm, there were significant differences in the length of procedure time between the groups grouped by the remaining three factors. And there was a significant difference in the primary patency rate between the group with blunt stump and the group without blunt stump and also between the group with occlusion lesions ≥ 2 cm and the group with occlusion lesions <2 cm. The operation time of cluster 1 was longer than that of cluster 2. In terms of postoperative patency time, the primary patency time was significantly longer in the patients of cluster 2 compared with cluster 1 (P = 0.025). Conclusion Patients were divided into distinct two clusters. CVO/CVS of patients in cluster 1 was more challenging to be recanalized than that in cluster 2, and the primary patency time was significantly longer in the patients of cluster 2 compared with cluster 1. Blunt stump, side branches, occlusion lesions exceeding 2 cm, and calcification or organization are the four most critical predictors distinguishing 103 patients into two clusters.
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Huang Y, Abad-Santos M, Iyer RS, Monroe EJ, Malone CD. Imaging to intervention: Thoracic outlet syndrome. Clin Imaging 2022; 89:23-36. [PMID: 35689965 DOI: 10.1016/j.clinimag.2022.06.003] [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: 04/09/2022] [Revised: 05/21/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
Thoracic outlet syndrome (TOS) is a clinical disorder resulting from compression of the neurovascular bundle of the lower neck and upper chest. TOS can be categorized into neurogenic, venous, and arterial subtypes which result from anatomical compression of the brachial plexus, subclavian vein, and subclavian artery, respectively. This can lead to neurogenic pain as well as vascular injury with thrombosis and thromboembolism. Interventional and diagnostic radiologists play a critical role in the imaging diagnosis and treatment of vascular TOS. Prompt imaging and endovascular management with surgical collaboration has been shown to provide the most successful and long-lasting clinical outcomes, from vessel patency to symptom relief. In this article, we review the anatomy and clinical presentations of TOS as well as the initial imaging modalities used for diagnosis. Furthermore, we detail the role of the diagnostic and interventional radiologist in the management of TOS, including pre-procedure and endovascular interventions, along with medical and surgical treatments. PRECIS: Diagnostic and Interventional Radiologists play a key role in diagnosis and management of vascular thoracic outlet syndromes and are critical for timely and successful outcomes.
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Affiliation(s)
- Yijin Huang
- Emory University, Atlanta, GA, United States of America
| | - Matthew Abad-Santos
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Ramesh S Iyer
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Eric J Monroe
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Christopher D Malone
- Mallinckrodt Institute of Radiology at Washington University School of Medicine, St. Louis, MO, United States of America.
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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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Sharp recanalization for treatment of central venous occlusive disease in hemodialysis patients. J Vasc Surg Venous Lymphat Disord 2021; 10:306-312. [PMID: 34438087 DOI: 10.1016/j.jvsv.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of the present study was to evaluate the technical feasibility and safety of sharp recanalization for central venous occlusive disease (CVOD) in patients requiring hemodialysis. METHODS Patients with CVOD requiring hemodialysis who had undergone endovascular recanalization using sharp devices, including the stiff end of a guidewire, Chiba needle, or RUS-100 to cross occluded segments after conventional techniques had failed were included. The needle was guided toward a target placed at the opposite end of the occlusion. Although the guidewire was passed though the occlusion, subsequent procedures such as percutaneous transluminal angioplasty could be performed. RESULTS A total of 27 sharp recanalization procedures in 25 patients were performed. Two attempts failed, 1 patient had undergone two separate successful procedures, and 23 procedures in 23 patients were successful. The overall technique success was 92.6%. The stiff end of a guidewire was the first choice for all the procedures, and recanalization was achieved in 18 patients (66.7%). A Chiba biopsy needle was used in six procedures (22.2%), with 100% technical success. A RUPS-100 set was used in two procedures (7.4%), with one aborted because of concern for complications. The occlusion was subsequently crossed using a Chiba needle. Four minor adverse events (two of mediastinal hematoma and two of chest pain) had occurred, and two major adverse events (pericardial tamponade and acute pleural effusion in one patient [4%], treated with the guidewire stiff-end technique, who recovered after drainage) had occurred. CONCLUSIONS Sharp recanalization is safe and feasible with high technical success for CVOD in patients requiring hemodialysis who cannot be recanalized using conventional techniques.
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Noh SY, Goo DE, Kim YJ, Yang SB, Lee JM, Lee WH. Sharp Needle Recanalization Technique for Peripheral Hemodialysis Arteriovenous Fistula Occlusion. Cardiovasc Intervent Radiol 2021; 44:1809-1816. [PMID: 34258680 DOI: 10.1007/s00270-021-02809-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the efficacy of a percutaneous sharp needle recanalization technique for the treatment of peripheral hemodialysis arteriovenous fistula (AVF) occlusion. MATERIALS AND METHODS This study included 13 patients (14 procedures) between May 2010 and February 2020 with non-thrombotic AVF occlusion wherein guidewire passage through the occluded segment had failed. We successfully passed the guidewire through the occluded segment using a sharp needle recanalization technique with Chiba or Colapinto needles, under ultrasound or fluoroscopic guidance. The type of AVF, site and length of occlusion, technical success, complications, and long-term patency were analyzed. RESULTS Technical success was achieved in 12 (85.7%) out of 14 procedures. The procedure failed in two patients due to the poor angle of approach in the axillary area and diffuse severe stenosis in the draining cephalic vein. In eight procedures, sharp needle recanalization was performed under ultrasound guidance, while the other six procedures were performed under fluoroscopic guidance. Chiba and Colapinto needles were used in five and nine procedures, respectively. The mean length of occlusion was 2.7 cm (range 1.8-4.2 cm). There was one case of mild complication, that is, mild contrast extravasation, which was treated by stent deployment. The post-intervention primary patency rates at 6 months, 1 year, and 2 years were 81.8%, 36.4%, and 18.2%, respectively. CONCLUSION The results of this limited series suggest that the sharp needle recanalization technique is a simple and effective method for the treatment of peripheral non-thrombotic AVF occlusion.
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Affiliation(s)
- Seung Yeon Noh
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | - Dong Erk Goo
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul, 04401, Korea.
| | - Yong Jae Kim
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul, 04401, Korea
| | - Seung Boo Yang
- Department of Radiology, Soon Chun Hyang University Hospital, Gumi, Korea
| | - Jae Myeong Lee
- Department of Radiology, Soon Chun Hyang University Hospital, Bucheon, Korea
| | - Woong Hee Lee
- Department of Radiology, Soon Chun Hyang University Hospital, Cheonan, Korea
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Wu XW, Zhao XY, Li X, Li JX, Liu ZY, Huang Z, Zhang L, Sima CY, Huang Y, Chen L, Zhou S. Effectiveness of sharp recanalization of superior vena cava-right atrium junction occlusion. World J Clin Cases 2021; 9:3848-3857. [PMID: 34141741 PMCID: PMC8180228 DOI: 10.12998/wjcc.v9.i16.3848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conventional recanalization techniques may fail in patients with completely occluded superior vena cava (SVC).
AIM To analyze the effectiveness and complications of sharp recanalization for completely occluded SVC.
METHODS This was a retrospective study of patients that underwent puncture and recanalization of the SVC between January 2016 and December 2017 at our hospital. Sharp recanalization was performed using the RUPS-100 system. The patients were followed for 12 mo. The main outcomes were the patency rate of SVC and arteriovenous fistula flow during dialysis.
RESULTS The procedure was successful in all 14 patients (100%). Blood pressure in the distal SVC decreased in all 14 cases (100%) from 26.4 ± 2.7 cmH2O to 14.7 ± 1.3 cmH2O (P < 0.05). The first patency rates of the SVC at 24 h and at 3, 6, 9 and 12 mo after sharp recanalization were 100%, 92.9%, 85.7%, 78.6% and 71.4%, respectively. There were two (14.3%) severe, one (7.1%) moderate and one (7.1%) minor complication. The severe complications included one case of pericardial tamponade and one case of hemothorax.
CONCLUSION The results suggest that sharp recanalization can be an additional tool to extend or renew the use of an occluded upper extremity access for hemodialysis. This could be of use in patients with long-term maintenance hemodialysis in whom the maintenance of central venous access is often a challenge.
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Affiliation(s)
- Xiao-Wen Wu
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Xu-Ya Zhao
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Xing Li
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Jun-Xiang Li
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Zong-Yang Liu
- Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Zhi Huang
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Ling Zhang
- Department of Nursing, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Chong-Yang Sima
- Department of Nephrology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Yu Huang
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Lei Chen
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Shi Zhou
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
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Long S, Sutphin PD, Kalva SP. Revascularization of Chronic Iliac Vein Occlusion Using Balloon-Assisted Transseptal Needle Puncture Technique. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1728996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Objectives To evaluate the utility of a transseptal needle for balloon-assisted sharp recanalization of chronically occluded central venous structures.
Background Chronically occluded central veins are not an uncommon problem, which may arise due to a plethora of reasons. Traditionally, wire and catheter techniques are often used first in an attempt to reestablish flow. When these methods fail, more aggressive techniques are employed, such as sharp recanalization using the back end of wires, Teflon-coated wires, or Rosch–Uchida or Colapinto needles. However, utilization of transseptal needles, traditionally reserved for cardiac procedures, has rarely been described.
Methods Transseptal needle was utilized for balloon-assisted sharp recanalization after traditional wire and catheter techniques failed in revascularization of chronically occluded iliac veins.
Results Transseptal needle was utilized successfully in two cases in revascularization of chronically occluded central veins.
Conclusion Transseptal needle is a viable tool to add to the interventional radiologists’ armamentarium in reestablishing flow in chronically occluded central veins.
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Affiliation(s)
- Simon Long
- Department of Vascular and Interventional Radiology, University of California Irvine, Orange, California, United States
| | - Patrick D. Sutphin
- Department of Vascular and Interventional Radiology, GRB-290 Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Sanjeeva P. Kalva
- Department of Vascular and Interventional Radiology, GRB-290 Massachusetts General Hospital, Boston, Massachusetts, United States
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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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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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Woerner A, Shin DS, Vaidya SS, Jones ST, Meissner MH, Monroe EJ, Hage AN, Chick JFB. Percutaneous Extra-Anatomic Double-Barrel Bypass for Salvage of Hemodialysis Access and Treatment of Venous Occlusive Disease. Cardiovasc Intervent Radiol 2020; 43:1942-1945. [PMID: 32808202 DOI: 10.1007/s00270-020-02615-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/02/2020] [Indexed: 11/26/2022]
Abstract
A woman with an upper extremity brachioaxillary arteriovenous dialysis graft presented with a 9-month history of profound ipsilateral arm swelling and numbness secondary to chronic axillosubclavian vein occlusion. Previous endovascular and open venous recanalization attempts were unsuccessful. A totally percutaneous extra-anatomic venous bi-bypass was created to salvage the dialysis access circuit and reconstruct the deep venous system. Using overlapping Viabahn stent-grafts, two parallel bypasses were created from the arteriovenous graft and brachial vein, respectively, to the brachiocephalic vein. The hemodialysis graft regained function. Upper extremity symptoms resolved within 48 h. This is the first reported percutaneous double-barrel technique of extra-anatomic venous bypass creation for simultaneous management of a failed dialysis access and chronic venous occlusive disease.
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Affiliation(s)
- Andrew Woerner
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - David S Shin
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Sandeep S Vaidya
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Sean T Jones
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Mark H Meissner
- Division of Vascular Surgery, Department of Surgery, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Eric J Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Anthony N Hage
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
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Li N, Huang YH. Delayed pericardial tamponade following central venous recanalization. J Vasc Access 2020; 22:979-983. [PMID: 32611236 DOI: 10.1177/1129729820938177] [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: 11/17/2022] Open
Abstract
A patient with central venous occlusion at the junction of the superior vena cava and right atrium underwent endovascular revascularization. The leakage of contrast agents was detected during sharp recanalization that was then managed with covered stent deployment. The initial symptom of facial swelling disappeared and the vital signs were stable after treatment. Regrettably, the patient suffered from the clinical features of cardiac tamponade on the third day post-treatment, which was confirmed by computed tomography. Finally, a pericardial effusion was drained, leading to dramatic improvement in the cardiovascular status of the patient.
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Affiliation(s)
- Nan Li
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong-Hui Huang
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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16
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Outcome of Central Vein Occlusion Recanalization in Hemodialysis Patients and Predictors for Success: A Retrospective Study. J Belg Soc Radiol 2020; 104:20. [PMID: 32405611 PMCID: PMC7207257 DOI: 10.5334/jbsr.1991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Catheter-directed treatment is the standard approach for the management of chronic central venous occlusion. Purpose: The objective of this study is to report the outcome of conventional recanalization of chronic central vein occlusion in hemodialysis patients and to determine the predictors for success. Material and Methods: All hemodialysis patients who underwent endovascular recanalization of central vein occlusion from January 2012 to December 2016 were retrospectively evaluated. The procedure was percutaneous transluminal angioplasty. Stenting was performed in case of a significant recoil stenosis. Kaplan-Meier analysis was used to evaluate central vein patency. Univariate analysis and multivariate logistic regression were used to calculate the predictive factors. Results: Ninety-seven patients (mean age, 61.2 years; range, 25‒89 years old) with 97 central vein occlusions were enrolled. Technical success was achieved in 49 patients (50.5%). The primary patency rates of central veins at 6 and 12 months were achieved in 17 patients (34.4%) and 8 patients (15.8%), respectively. The assisted primary patency rates at 6 and 12 months were achieved in 38 patients (77.3%) and 30 patients (61%), respectively. Patient age ≥60 years and a tapered-type of lesion were significant predictive factors for successful recanalization. Conclusion: Endovascular treatment of the central vein occlusion using a conventional technique is moderately effective and safe. Angioplasty alone and stenting were not significantly different in terms of patency rate. The age of the patients and type of occlusion were significant predictors for successful recanalization.
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Chen MCY, Weng MJ. Percutaneous Extraanatomic Bypass for Treatment of Central Venous Occlusions in Patients Undergoing Hemodialysis. AJR Am J Roentgenol 2020; 214:477-481. [DOI: 10.2214/ajr.19.21721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Matt Chiung-Yu Chen
- Department of Interventional Radiology, Yuan's General Hospital, No. 162, Cheng-gong 1st Rd, Lingya District, Kaohsiung City 802, Taiwan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Mei-Jui Weng
- Department of Interventional Radiology, Yuan's General Hospital, No. 162, Cheng-gong 1st Rd, Lingya District, Kaohsiung City 802, Taiwan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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18
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Yang L, Yang L, Zhao Y, Wang Y, Yu Y, Salerno S, Li Y, Fu P, Cui T. The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study. Hemodial Int 2019; 24:52-60. [PMID: 31808994 DOI: 10.1111/hdi.12804] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/25/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ling Yang
- Outpatient DepartmentWest China Hospital of Sichuan University Chengdu China
| | - Letian Yang
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Yuliang Zhao
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Yating Wang
- Department of Internal MedicineLouis A Weiss Memorial Hospital Chicago Illinois USA
| | - Yang Yu
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Stephen Salerno
- Department of BiostatisticsSchool of Public Health, University of Michigan Ann Arbor Michigan USA
| | - Yi Li
- Department of BiostatisticsSchool of Public Health, University of Michigan Ann Arbor Michigan USA
- Kidney Epidemiology and Cost CenterUniversity of Michigan Ann Arbor Michigan USA
| | - Ping Fu
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Tianlei Cui
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
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McDevitt JL, Srinivasa RN, Gemmete JJ, Hage AN, Srinivasa RN, Bundy JJ, Chick JFB. Approach, Technical Success, Complications, and Stent Patency of Sharp Recanalization for the Treatment of Chronic Venous Occlusive Disease: Experience in 123 Patients. Cardiovasc Intervent Radiol 2018; 42:205-212. [DOI: 10.1007/s00270-018-2090-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022]
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Cox DRA, Chiang N, Ramdwar N, Chuen J, Asadi H, Brooks M. A Fine Needle Recanalization Technique for Iliac Artery Occlusions in Endovascular Surgery. Ann Vasc Surg 2018; 54:328-334. [PMID: 30081164 DOI: 10.1016/j.avsg.2018.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Endovascular intervention for chronic total occlusions (CTOs) in aortoiliac occlusive disease (AIOD) poses technical challenges. In this manuscript, our experience of fine needle recanalization for the treatment of iliac artery CTO is described. METHOD A prospective database recorded treatment of 11 limbs in 11 patients since 2011 using this technique. The majority of these CTO were of the common iliac artery (n = 9). RESULTS Technical success rate was 91% (n = 10). One failed case was due to tortuous iliac anatomy. There was no restenosis of the treated segments at 8 weeks and no major complications, perforations, major limb loss, or periprocedural mortality. CONCLUSIONS This technique is a safe and viable adjunct for difficult CTO in AIOD with suitable anatomy. It benefits from being a simple, low-profile, low-cost coaxial system and should be part of the armamentarium with other advanced endovascular techniques.
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Affiliation(s)
- Daniel R A Cox
- Department of Vascular Surgery, Austin Hospital, Melbourne, Australia.
| | - Nathaniel Chiang
- Department of Vascular Surgery, Austin Hospital, Melbourne, Australia
| | - Noel Ramdwar
- Department of Vascular Surgery, Austin Hospital, Melbourne, Australia
| | - Jason Chuen
- Department of Vascular Surgery, Austin Hospital, Melbourne, Australia
| | - Hamed Asadi
- Department of Radiology, Austin Hospital, Melbourne, Australia
| | - Mark Brooks
- Department of Radiology, Austin Hospital, Melbourne, Australia
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Kim YJ, Yang SB, Lee WH, Kim YJ, Lee JM, Goo DE, Kim BJ. Central vein rupture during percutaneous transluminal angioplasty for central vein stenosis or occlusion in haemodialysis patients. SA J Radiol 2017. [DOI: 10.4102/sajr.v21i1.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Endovascular treatments such as percutaneous transluminal angioplasty (PTA) and stent placements are becoming the standard method in managing haemodialysis access failure. Venous rupture is the most common complication during endovascular procedures. Complications during endovascular treatments of central venous stenosis or occlusion have been rarely reported.Objectives: To investigate the incidence and management of central vein rupture while performing PTA for central vein stenosis or occlusion in haemodialysis patients.Method: Between 1998 and 2013, PTA was performed using various techniques in haemodialysis patients for central vein stenoses (n = 2437) and occlusions (n = 666). When the guide wire passed through the stenosis or the occlusion, PTA was performed regardless of the presence of a venous rupture. The incidence of central vein rupture was analysed using the chi-square test according to the gender, location, right versus left, presence of thrombosis and stenosis versus occlusion. Percutaneous management of central vein rupture was also evaluated.Results: Central vein rupture occurred in 12 cases (0.39%). All ruptures occurred in the cases with occlusion. Only stenosis versus occlusion reflected a significant correlation (p < 0.001) with central vein rupture. Central vein ruptures were managed by low-pressure balloon tamponade (n = 2), stent/stent-graft (n = 5) and balloon-mediated haemostasis blocking venous inflow followed by the observation (n = 5).Conclusion: Central vein rupture is a rarely occurring complication while performing PTA for central vein stenosis and occlusion, and the majority can be successfully managed by percutaneous techniques.
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Success Rate and Complications of Sharp Recanalization for Treatment of Central Venous Occlusions. Cardiovasc Intervent Radiol 2017; 41:73-79. [PMID: 28879566 DOI: 10.1007/s00270-017-1787-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate success and safety of needle (sharp) recanalization as a method to re-establish access in patients with chronic central venous occlusions. MATERIALS AND METHODS Thirty-nine consecutive patients who underwent this procedure were retrospectively reviewed to establish success rate and associated complications. In all cases, a 21- or 22-gauge needle was used to restore connection between two chronically occluded segments after conventional wire and catheter techniques had failed. The needle was guided toward a target placed through a separate access by fluoroscopic guidance. When successful, the procedure was completed by placing a catheter, ballooning the segment, and/or stenting. RESULTS The procedure was successful in 37 of the 39 patients (95%). The vast majority of the treated lesions were in the SVC and/or right innominate vein. Occlusions ranged in length between 10 and 110 mm, and the average length of occluded venous segment was 40 mm in the treated group. There were four minor (SIR classification B) complications involving pain management after the procedure. There were two major (SIR classification D) complications both of which involved hemorrhage into the pericardium treated with covered stents (5.1%). CONCLUSIONS Sharp recanalization is a viable procedure for patients who have exhausted standard wire and catheter techniques. The operator performing this procedure should be familiar with potential complications so that they can be addressed urgently if needed.
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Arabi M, Ahmed I, Mat’hami A, Ahmed D, Aslam N. Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience. Cardiovasc Intervent Radiol 2015; 39:927-34. [DOI: 10.1007/s00270-015-1270-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
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Beathard GA, Eradat J. Chronically Occluded Arteriovenous Fistula Salvaged by Sharp Needle Recanalization. Semin Dial 2015; 28:E58-63. [DOI: 10.1111/sdi.12451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sharp Recanalization for Chronic Left Iliac Vein Occlusion. Cardiovasc Intervent Radiol 2012; 35:938-41. [DOI: 10.1007/s00270-012-0346-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/29/2011] [Indexed: 12/01/2022]
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Sharp Needle Recanalization for Salvaging Hemodialysis Accesses with Chronically Occluded Peripheral Outflow. J Vasc Access 2011; 13:22-8. [DOI: 10.5301/jva.2011.8424] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess the effectiveness of sharp needle recanalization (SNR) for treatment of chronically occluded venous outflow in hemodialysis access. Methods A retrospective analysis of patient records from January 2006 to March 2010 was conducted. Forty-four hemodialysis patients (31 fistulas, 13 grafts) were referred for arm swelling (18%), excessive bleeding after dialysis (29%), and thrombosis (53%). All patients had chronic occlusion of the outflow vein which failed conventional recanalization techniques. A new outflow pathway was established by advancing a 21g needle and dilating the subcutaneous tract to bridge the fistula body to a juxtaposed patent vein. If necessary, uncovered or covered stents were utilized to maintain patency of the newly formed subcutaneous tract. Results Forty-four patients underwent 45 SNR procedures, with restoration of normal function and complete relief of symptoms in 40 (91%) patients. The average tract length was 15 mm (range, 1 to 32) and the average dilatation diameter was 8 mm. During the initial SNR procedure, bare metal (n=21) or covered (n=5) stents were inserted in 26 patients. The average follow-up was 18.4 months (range, 0.2 to 48 months). No major complications were observed with the procedure. At 12 months, the primary access, primary tract, and secondary access patencies were 10%, 51%, and 92%, respectively. Percutaneous thrombectomy procedures were performed at a rate of 1.16 per access-year and the number of interventions within the tract was 0.94 per access-year. Conclusions Sharp needle recanalization is an effective percutaneous treatment for restoring function to hemodialysis accesses with chronically occluded venous outflow pathways.
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Recanalization of dialysis catheter-related subclavian vein occlusion using a re-entry device: report of two patients. Cardiovasc Intervent Radiol 2011; 34:207-11. [PMID: 20694466 DOI: 10.1007/s00270-010-9955-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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