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Approach, Technical Success, Complications, and Stent Patency of Sharp Recanalization for the Treatment of Chronic Venous Occlusive Disease: Experience in 123 Patients

  • Clinical Investigation
  • Venous Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To report the technical success and complications following sharp recanalization of chronic venous occlusions.

Materials and Methods

A total of 123 patients, including 75 (61.0%) men and 48 (39.0%) women, with mean age of 50.5 ± 17.5 years (range 19–90 years), underwent sharp recanalization of chronic venous occlusions. The etiologies of occlusion were chronic deep venous thrombosis (n = 43; 35.0%), prior central venous access (n = 39; 31.7%), indwelling cardiac leads (n = 21; 17.1%), and occluded venous stents (n = 20; 16.3%). The sites of venous occlusion included 59/123 (48.0%) thoracic central veins, 37 (30.1%) non-thoracic central veins, and 27 (22.0%) peripheral veins. Median length of occlusion was 3.2 ± 1.4 cm (range 1.3–10.9 cm).

Results

Sharp recanalization was most commonly attempted with transseptal needles in 108/123 (87.8%), with a mean number of 1.2 ± 0.4 crossing devices per patient (range 1–4 devices). Targeting devices included a loop snare (n = 92; 74.8%), partially deployed Wallstent (n = 21; 17.1%), partially deployed Amplatzer vascular plug (n = 8; 6.5%), and an angioplasty balloon (n = 3; 2.4%). Technical success was achieved in 111 (90.2%) patients. There were 3 (2.4%) severe, 1 (0.8%) moderate, and 7 (5.7%) minor adverse events. Severe adverse events included 1 case each of pericardial tamponade, hemothorax, and inferior vena cava filter occlusion. 88 (71.5%) patients had venous stents placed; at the last follow-up examination, 68/86 (79.0%) stents were patent.

Conclusion

Sharp recanalization has a high technical success and low rate of adverse events in the recanalization of chronic venous occlusions.

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References

  1. Kundu S. Central venous obstruction management. Semin Intervent Radiol. 2009;26(2):115–21.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lumsden AB, MacDonald MJ, et al. Central venous stenosis in the hemodialysis patient: incidence and efficacy of endovascular treatment. Cardiovasc Surg. 1997;5(5):504–9.

    Article  CAS  PubMed  Google Scholar 

  3. Allen AW, Megargell JL, et al. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol. 2000;11(10):1309–14.

    Article  CAS  PubMed  Google Scholar 

  4. Raju S. Best management options for chronic iliac vein stenosis and occlusion. J Vasc Surg. 2013;57(4):1163–9.

    Article  PubMed  Google Scholar 

  5. Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist’s perspective. Semin Dial. 2007;20(1):53–62.

    Article  PubMed  Google Scholar 

  6. Cohen EI, Beck C, et al. Success rate and complications of sharp recanalization for treatment of central venous occlusions. Cardiovasc Interv Radiol. 2018;41(1):73–9.

    Article  Google Scholar 

  7. Goo DE, Kim YJ, et al. Use of a Rösch-Uchida needle for recanalization of refractory dialysis-related central vein occlusion. Am J Roentgenol. 2010;194(5):1352–6.

    Article  Google Scholar 

  8. Hanauer DA, Mei Q, et al. Supporting information retrieval from electronic health records: a report of University of Michigan’s nine-year experience in developing and using the Electronic Medical Record Search Engine (EMERSE). J Biomed Inform. 2015;55:290–300.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dolmatch BL, Gurley JC, et al. Society of interventional radiology reporting standards for thoracic central vein obstruction. J Vasc Interv Radiol. 2018;29(4):454–60.

    Article  PubMed  Google Scholar 

  10. Williams DM. Iliocaval reconstruction in chronic deep vein thrombosis. Technol Vasc Interv Radiol. 2014;17(2):109–13.

    Article  Google Scholar 

  11. Khaja MS, Chick JFB, et al. Fluoroscopic targeting of wallstents and amplatzer vascular plugs in sharp recanalization of chronic venous occlusions. Cardiovasc Interv Radiol. 2017;40(11):1777–83.

    Article  Google Scholar 

  12. Chick JFB, Jo A, et al. Endovascular iliocaval stent reconstruction for inferior vena cava filter-associated iliocaval thrombosis: approach, technical success, safety, and two-year outcomes in 120 patients. J Vasc Interv Radiol. 2017;28(7):933–9.

    Article  PubMed  Google Scholar 

  13. Khalilzadeh O, Baerlocher MO, et al. Proposal of a new adverse event classification by the society of interventional radiology standards of practice committee. J Vasc Interv Radiol. 2017;28(10):1432.

    Article  PubMed  Google Scholar 

  14. Gupta H, Murphy TP, Soares GM. Use of a puncture needle for recanalization of an occluded right subclavian vein. Cardiovasc Interv Radiol. 1998;21(6):508–11.

    Article  CAS  Google Scholar 

  15. Murphy TP, Webb MS. Percutaneous venous bypass for refractory dialysis-related subclavian vein occlusion. J Vasc Interv Radiol. 1998;9(6):935–9.

    Article  CAS  PubMed  Google Scholar 

  16. Miyayama S, Minami T, et al. Small needle puncture of a central venous occlusion in a hemodialysis patient that could not be traversed by a conventional technique. Cardiovasc Interv Ther. 2014;29(3):261–5.

    Article  PubMed  Google Scholar 

  17. Lang EV, Vrachliotis TG, Brophy DP. Sharp recanalization for chronic central venous occlusions. Tech Vasc Interv Radiol. 2000;3(1):21–8.

    Google Scholar 

  18. Ferral H, Bjarnason H, et al. Recanalization of occluded veins to provide access for central catheter placement. J Vasc Interv Radiol. 1996;7(5):681–5.

    Article  CAS  PubMed  Google Scholar 

  19. Beathard GA, Eradat J. Chronically occluded arteriovenous fistula salvaged by sharp needle recanalization. Semin Dial. 2015;28(6):E58–63.

    Article  PubMed  Google Scholar 

  20. Athreya S, Scott P, et al. Sharp recanalization of central venous occlusions: a useful technique for haemodialysis line insertion. Br J Radiol. 2009;82(974):105–8.

    Article  CAS  PubMed  Google Scholar 

  21. Honnef D, Wingen M, et al. Sharp central venous recanalization by means of a TIPS needle. Cardiovasc Interv Radiol. 2005;28(5):673–6.

    Article  Google Scholar 

  22. Ito N, Isfort P, et al. Sharp recanalization for chronic left iliac vein occlusion. Cardiovasc Interv Radiol. 2012;35(4):938–41.

    Article  Google Scholar 

  23. Guimaraes M, Schonholz C, et al. Radiofrequency wire for the recanalization of central vein occlusions that have failed conventional endovascular techniques. J Vasc Interv Radiol. 2012;23(8):1016–21.

    Article  PubMed  Google Scholar 

  24. Davis RM, David E, et al. Radiofrequency guide wire recanalization of venous occlusions in patients with malignant superior vena cava syndrome. Cardiovasc Interv Radiol. 2012;35(3):676–9.

    Article  Google Scholar 

  25. Malik AK, Bhalla N, et al. Percutaneous reconstruction of chronic total occlusion of brachiocephalic vein using transseptal needle in dialysis-dependent patient. Cardiovasc Interv Ther. 2016;31(2):136–9.

    Article  PubMed  Google Scholar 

  26. Arabi M, Ahmed I, et al. Sharp central venous recanalization in hemodialysis patients: a single-institution experience. Cardiovasc Interv Radiol. 2016;39(6):927–34.

    Article  Google Scholar 

  27. Porter D, Rundback JH, Miller S. Sharp recanalization using a subintimal reentry device, angioplasty, and stent placement for severely symptomatic iliofemoral deep venous thrombosis secondary to congenital aplasia of the inferior vena cava. J Vasc Interv Radiol. 2010;21(11):1765–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Division of Vascular and Interventional Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA

    Joseph L. McDevitt

  2. Department of Interventional Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA

    Ravi N. Srinivasa

  3. Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Joseph J. Gemmete, Rajiv N. Srinivasa & Jacob J. Bundy

  4. Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Philadelphia, PA, 19107, USA

    Anthony N. Hage

  5. Department of Cardiovascular and Interventional Radiology, INOVA Alexandria Hospital, 4320 Seminary Road, Alexandria, VA, 22304, USA

    Jeffrey Forris Beecham Chick

Authors
  1. Joseph L. McDevitt
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  2. Ravi N. Srinivasa
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  3. Joseph J. Gemmete
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  6. Jacob J. Bundy
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Corresponding author

Correspondence to Jeffrey Forris Beecham Chick.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

This study has obtained Institutional Review Board Approval, and the need for informed consent was waived.

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McDevitt, J.L., Srinivasa, R.N., Gemmete, J.J. et al. 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 42, 205–212 (2019). https://doi.org/10.1007/s00270-018-2090-1

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  • DOI: https://doi.org/10.1007/s00270-018-2090-1

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