Efficacy and safety of recanalization with transseptal needle for chronic total occlusion of the brachiocephalic vein in hemodialysis patients

Yin, Xi; Shen, Xiaoye; Zhou, Zhongxin; Chen, Qin; Zhou, Li; Cui, Tianlei

doi:10.21037/atm-20-5369

Cited by 10 publications

(2 citation statements)

References 32 publications

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“…In 2020, we reported the use of a transseptal needle in 16 cases with BV occlusion, with a low success rate of 81.25% (13/16). The septal puncture needle was too stiff to pass through tight angles (24). In the current study, the blunt impingement technique was initially applied to all patients who failed the standard catheter guidewire technique.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of blunt impingement followed by a sharp recanalization technique in hemodialysis patients with refractory central vein occlusion: a single-center experience

Sun¹,

Zhao²,

Salerno³

et al. 2022

Ann Transl Med

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Background: Central vein occlusion (CVO) is a serious problem in hemodialysis patients. There is an unsatisfactory result for refractory CVO by sharp recanalization alone. This study evaluated the efficacy and safety of blunt impingement followed by sharp recanalization for the treatment of CVO in hemodialysis patients.Methods: This study retrospectively examined hemodialysis patients with CVO who failed to recanalize using standard guidewire and catheter techniques in our department. In the first instance, all CVOs were recanalized using blunt impingement techniques, including a 6-Fr long sheath (Cook Incorporated, Bloomington, IN USA) and an 8-Fr sheath of Rosch-Uchida Transjugular Liver Access Set (RUPS-100; Cook Incorporated, Bloomington, IN, USA). If this was not successful, sharp recanalization devices were applied, including the stiff tip of a guidewire (Terumo, Tokyo, Japan), the RUPS-100, and the percutaneous transhepatic cholangial drainage (PTCD) needle (Cook Incorporated, USA). All patients were followed up at least 4 months postoperatively. The technical success rate, arteriovenous access patency rates, and operationrelated complications were analyzed. Results:The procedural success rate was 100.0% (30 of 30). Thirty patients with CVO underwent blunt impingement with a technique success rate of 70.0% (21 of 30), and 9 patients received sharp recanalization after failed blunt impingement, with a technique success rate of 100.0% (9 of 9). The primary patency rates at 6 and 12 months postoperatively were 86.7% and 53.3%, respectively. The primary assisted patency rates were 93.3% and 63.3%, and the secondary patency rates were 93.3% and 70.0% at 6 and 12 months, respectively. One major procedure-related complication was detected, namely, a small injury of the superior vena cava (SVC) wall in a patient receiving recanalization via the stiff end of a guidewire, but this did not require further treatment.Conclusions: It is potentially effective and safe for interventionalists to use blunt impingement followed by sharp recanalization techniques to treat chronic CVO that is refractory to traversal using traditional catheter and guidewire techniques.

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Section: Discussionmentioning

confidence: 99%

The efficacy and safety of blunt impingement followed by a sharp recanalization technique in hemodialysis patients with refractory central vein occlusion: a single-center experience

Sun¹,

Zhao²,

Salerno³

et al. 2022

Ann Transl Med

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“…The curved trocar needle provides directionality and robust torquability to the 22G Chiba needle. Other researchers have described using a trans-septal needle for sharp recanalization ( 21 ). Another group reported performing sharp recanalization with an Outback LTD catheter, which is a single-lumen over-the-wire 6F sheath-compatible catheter containing a curved nitinol cannula within the outer shaft.…”

Section: Techniques For Crossing the Occlusionmentioning

confidence: 99%

Thoracic central venous occlusion from the interventional radiology perspective

Rashwan¹,

Shwaiki²,

Partovi³

et al. 2023

Cardiovasc Diagn Ther

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Central venous occlusion is a common condition in certain patient populations, with significant associated morbidity. Symptoms range from mild arm swelling to respiratory distress and can be particularly troublesome in the end stage renal disease population when related to dialysis access and function. Crossing completely occluded vessels is often the most challenging step and various techniques exist to accomplish this. Traditionally, blunt and sharp recanalization techniques are used to cross occluded vessels and are described in detail. Even with experienced providers there are lesions which prove to be too difficult and are refractory to traditional approaches. We discuss advanced techniques such as with radiofrequency guidewires as well as newer technologies which offer an alternative pathway to re-establishing access. These emerging methods have demonstrated procedural success in the majority of cases where traditional techniques were futile. Following recanalization, angioplasty with or without stenting is typically performed and restenosis is a commonly encountered complication. We discuss angioplasty and the emerging use of drug-eluting balloons in venous thrombosis. Subsequently, in regards to stenting we discuss the indications and multitude of available types including novel venous stents with their respective strengths and drawbacks. Potential feared complications such as venous rupture with balloon angioplasty and stent migration are discussed along with our recommendations to reduce their risk of occurrence and promptly manage them when they do unfortunately occur.

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Management of Central Venous Stenoses and Occlusions

Kitrou

Κατσάνος

Karnabatidis

2023

Cardiovasc Intervent Radiol

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Symptomatic central venous stenosis and occlusion remains the gordian knot of vascular access. Advances in techniques, like sharp recanalization, allowed for improved success rates in crossing these difficult lesions. There is also increasing evidence of new devices in treating central venous stenosis and, at the same time, improving the time needed between interventions. High-pressure balloons, paclitaxel-coated balloons, bare metal stents and covered stents have been tested with an aim to offer additional treatment options, although obstacles still exist. In the current review, authors describe relevant techniques and options, provide the evidence and evaluate the actual implementation of these devices in this demanding field.

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Efficacy and safety of recanalization with transseptal needle for chronic total occlusion of the brachiocephalic vein in hemodialysis patients

Cited by 10 publications

References 32 publications

The efficacy and safety of blunt impingement followed by a sharp recanalization technique in hemodialysis patients with refractory central vein occlusion: a single-center experience

The efficacy and safety of blunt impingement followed by a sharp recanalization technique in hemodialysis patients with refractory central vein occlusion: a single-center experience

Thoracic central venous occlusion from the interventional radiology perspective

Management of Central Venous Stenoses and Occlusions

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