Radiofrequency Wire for the Recanalization of Central Vein Occlusions that Have Failed Conventional Endovascular Techniques

Guimarães, Marcelo; Schönholz, Claudio; Hannegan, Christopher; Anderson, Mike B.; Shi, June; Selby, Bayne

doi:10.1016/j.jvir.2012.05.049

Cited by 67 publications

(39 citation statements)

References 13 publications

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“…Sharp transversal followed by conventional angioplasty was capable in restoring SVC patency in the majority of the included patients. [11][12][13] However, the heated tip allows the wire to advance extraluminally easily and efforts should be made to avoid such misadventures. CVO is a common long-term complication in hemodialysis patients using central venous catheters and the mechanism remains unclear.…”

Section: Discussionmentioning

confidence: 99%

The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study

Yang

Zhao

et al. 2019

Hemodialysis International

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Introduction: Hemodialysis catheter-related superior vena cava (SVC) occlusions can cause considerable morbidity for patients and be challenging to treat if refractory to conventional guide wire transversal. This pilot study assessed the feasibility and safety of sharp recanalization of SVC occlusion in hemodialysis patients.Methods: This study retrospectively enrolled hemodialysis patients treated in West China Hospital diagnosed with SVC occlusion who failed traditional guide wire transversal from January 2014 to November 2017. In brief, a guide wire from the femoral approach was advanced to the lower end of the obstructive lesion to act as a target, while the stiff end of hydrophilic wire was advanced though a jugular approach. Under fluoroscopic guidance in biplane imaging, the occlusive SVC lesion was penetrated with the stiff wire that was snared and pulled through. Graded dilation of the SVC and subsequent tunneled-cuffed catheter implantation were performed. Demographic information and clinical outcomes were recorded and evaluated.Findings: Sixteen patients with a mean age of 62 AE 13 years (13 females and 3 males) who received SVC sharp recanalization were included in this study. The sharp recanalization procedure was successfully performed in 14 patients (87.5%). Two patients were complicated with SVC laceration and hemopericardium but remained asymptomatic and required no surgical repair. One patient suffered ventricular fibrillation during procedure. Despite the return of spontaneous circulation, the patient unfortunately died of gastrointestinal tract bleeding after 3 days in ICU. Follow-up suggested the 6-month catheter patency to be 92.85% and 12-month catheter patency to be 58.33%. No long-term procedure-related complications were recorded.Discussion: Sharp recanalization might be a feasible strategy in managing SVC occlusion in hemodialysis patients. The potential life-threatening complications (cardiac arrhythmia and SVC Correspondence to: laceration) necessitate strict eligibility screening, skillful operation, and avoidance of over-dilation of SVC.

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Section: Discussionmentioning

confidence: 99%

The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study

Yang

Zhao

et al. 2019

Hemodialysis International

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“…If conventional wire manipulation is not possible due to a recalcitrant obstruction or a completely discontinuous cava, sharp recanalization by means of the back end of a stiff wire, a thin-gauge needle, or powered wires (ie, radiofrequency/ laser-assisted) may be used (95). While these latter wires have the ability to penetrate through nearly any obstruction, they are no more directable than other sharp tools and, given the three-dimensional limitations of fluoroscopy, may not offer much more benefit except in very specific circumstances.…”

Section: Figure 12mentioning

confidence: 99%

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

Sista

Vedantham

Kaufman³

et al. 2015

Radiology

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“…11 To avoid this, a loop snare advanced from a femoral access site to the inferior aspect of the occlusion can be used as a target for the advancing wire. 25 Once the stenosis is crossed, the snare can be used to create through-and-through access to facilitate stent placement.…”

Section: Svc Rupture and Cardiac Tamponade As A Complication Of Stentingmentioning

confidence: 99%

Superior Vena Cava Rupture and Cardiac Tamponade Complicating the Endovascular Treatment of Malignant Superior Vena Cava Syndrome: A Case Report and Literature Review

Stevens

Butty

Johnson

2015

Semin intervent Radiol

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A 47-year-old man with known metastatic small cell lung cancer presented with 1 week of right arm swelling, facial flushing, shortness of breath, right hand weakness, and intermittent blurry vision. Physical examination revealed right upper extremity edema and facial plethora. Computed tomography (CT) of the chest confirmed enlargement of a right upper lobe mass causing near-complete occlusion of the right brachiocephalic vein and superior vena cava (SVC) (►Fig. 1), consistent with SVC syndrome (SVCS). After extensive discussion regarding the risks and benefits of the procedure, the patient elected to proceed with endovascular reconstruction of the central veins.Bilateral basilic vein access was obtained, and digital upper extremity venography confirmed near-complete occlusion of the SVC (►Fig. 2). The occlusion was traversed using a 0.035-inch wire and a 5F catheter, and intraluminal crossing was confirmed with contrast injection. Throughand-through access was obtained via the right common femoral vein, and the SVC and brachiocephalic veins were dilated using 8-and 10-mm balloons (►Fig. 3). Venogram immediately following the 10-mm angioplasty demonstrated contrast extravasation into the mediastinum and likely the pericardial space, indicative of SVC rupture (►Fig. 4). Ultrasound revealed a thin pericardial effusion, which, given the patient's history of radiation, was deemed sufficient to cause tamponade. Overlapping 13 mm Â 5 cm Viabahn-covered stents (Gore Medical, Flagstaff, AZ) were placed from the central aspect of the left brachiocephalic vein to the atriocaval junction (►Fig. 5). However, the patient rapidly decompensated, and despite aggressive resuscitation following advanced cardiac life support (ACLS) protocol, including pericardiocentesis, the patient expired on the table.

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Radiofrequency Wire for the Recanalization of Central Vein Occlusions that Have Failed Conventional Endovascular Techniques

Cited by 67 publications

References 13 publications

The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study

The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

Superior Vena Cava Rupture and Cardiac Tamponade Complicating the Endovascular Treatment of Malignant Superior Vena Cava Syndrome: A Case Report and Literature Review

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