CardioVascular and Interventional Radiology

, Volume 39, Issue 6, pp 927–934 | Cite as

Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience

  • Mohammad Arabi
  • Ishtiaq Ahmed
  • Abdulaziz Mat’hami
  • Dildar Ahmed
  • Naveed Aslam
Technical Note

Abstract

Purpose

We report our institutional experience with sharp central venous recanalization in chronic hemodialysis patients who failed standard techniques.

Materials and Methods

Since January 2014, a series of seven consecutive patients (four males and three females), mean age 35 years (18–65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n = 6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n = 1). The transseptal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava. Instead, transmediastinal SVC access using Chiba needle was obtained.

Results

Technical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arteriovenous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow-up time of 9 months (1–14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC.

Conclusion

Sharp central venous recanalization using the transseptal needle is feasible technique in patients who failed standard recanalization procedures. The potential high risk of complications necessitates thorough awareness of anatomy and proper technical preparedness.

Keywords

Sharp central venous recanalization Hemodialysis Chronic occlusion 

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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Mohammad Arabi
    • 1
  • Ishtiaq Ahmed
    • 1
  • Abdulaziz Mat’hami
    • 1
  • Dildar Ahmed
    • 2
  • Naveed Aslam
    • 2
  1. 1.Division of Endovascular Interventional Radiology, Department of Medical ImagingPrince Sultan Military Medical City (PSMMC)RiyadhKingdom of Saudi Arabia
  2. 2.Department of NephrologyPrince Sultan Military Medical City (PSMMC)RiyadhKingdom of Saudi Arabia

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