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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This study was not supported by any funding.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by CJRG and CYK. The first draft of the manuscript was written by CJRG, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Gallo, C.J.R., Ronald, J., Pabon-Ramos, W.M. et al. Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach. Cardiovasc Intervent Radiol 44, 784–788 (2021). https://doi.org/10.1007/s00270-020-02728-7
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DOI: https://doi.org/10.1007/s00270-020-02728-7