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Sharp Central Venous Recanalization by Means of a TIPS Needle

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Abstract

The purpose of this study was to perform an alternative technique for recanalization of a chronic occlusion of the left brachiocephalic vein that could not be traversed with a guidewire. Restoration of a completely thrombosed left brachiocephalic vein was attempted in a 76-year-old male hemodialysis patient with massive upper inflow obstruction, massive edema of the face, neck, shoulder, and arm, and occlusion of the stented right brachiocephalic vein/superior vena cava. Vessel negotiation with several guidewires and multipurpose catheters proved unsuccessful. The procedure was also non-viable using a long, 21G puncture needle. Puncture of the superior vena cava (SVC) at the distal circumference of the stent in the right brachiocephalic vein/superior vena cava, however, was feasible with a transjugular intrahepatic portosystemic shunt (TIPS) set under biplanar fluoroscopy using the distal end of the right brachiocephalic vein as a target, followed by balloon dilatation and partial extraction of thrombotic material of the left brachiocephalic vein with a wire basket. Finally, two overlapping stents were deployed to avoid early re-occlusion. Venography demonstrated complete vessel patency with free contrast media flow via the stents into the SVC, which was reconfirmed in follow-up examinations. Immediate clinical improvement was observed. Venous vascular recanalization of chronic venous occlusion by means of a TIPS needle is feasible as a last resort under certain precautions.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, University Hospital, Aachen, Germany

    Dagmar Honnef, Markus Wingen, Rolf W. Günther & Patrick Haage

Authors
  1. Dagmar Honnef
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  2. Markus Wingen
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  3. Rolf W. Günther
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  4. Patrick Haage
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Correspondence to Dagmar Honnef.

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Honnef, D., Wingen, M., Günther, R.W. et al. Sharp Central Venous Recanalization by Means of a TIPS Needle. Cardiovasc Intervent Radiol 28, 673–676 (2005). https://doi.org/10.1007/s00270-004-0323-y

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  • DOI: https://doi.org/10.1007/s00270-004-0323-y

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