expanding and balloon-mounted stents. A representative balloonmounted stent-assisted remodeling of an occluded Optease (Cordis, Inc) IVCF placed 3 years before is shown in the Fig. Self-expanding stents were deployed distally from the IVCF site to treat the entire obstructed segment. Technical success, clinical outcome, and duplex ultrasound assessment are reported throughout follow-up. Patients were maintained on chronic anticoagulation therapy.Results: Five patients (average age, 68; range, 60-77 years) had longstanding IVCF (average duration, 6.25 years; range, 3-10 years) and debilitating venous outflow obstruction with ulceration or venous claudication despite conservative management. Immediate technical success was achieved in all patients. There was no perioperative morbidity. All patients noted marked clinical improvement and duplex documentation of stent patency to date (average, 4.25 months; range, 1-7 months).Conclusions: Endovascular recananalization of chronically occluded IVCFs is technically feasible. Early results suggest the safety and efficacy of this approach to complex, iatrogenic venous outflow obstruction caused by chronic IVCF occlusion.
Objective(s):The Hemodialysis Reliable Outflow (HeRO) catheter has provided an innovative means to obtain hemodialysis access for patients with severe central venous occlusive disease. The outcomes of this novel treatment modality in a difficult population have yet to be clearly established.Methods: A retrospective review of HeRO catheter placement from June 2010 to present was performed. Patient hemodialysis access history, clinical complexity, complications, and outcomes were analyzed.Results: HeRO catheter placement was attempted 21 times in 19 patients (52% female), with an 86% success rate (three unsuccessful attempts). All but one was placed in the upper extremity. Mean follow-up after placement has been 6.8 Ϯ 5.5 months (range, 0.0-17.5 months). The primary indication for all HeRO catheter placements was central vein occlusion(s) and need for arteriovenous access. Patients averaged 2.0 previous (failed) accesses and multiple catheters. Seven patients had significant arterial issues in one or both upper extremities. Four HeRO catheters (23.5%), all in women, required ligation and removal for severe steal symptoms in the immediate postoperative period (P ϭ .01 vs men). Two deaths not thought to be related to HeRO occurred in the postoperative period. Three HeROs were placed above fistulas for rescue. All thrombosed Յ4 months, although fistulas remained open. Average time to initial failure, including thrombosis or explantation due to steal or infection, was 4.6 Ϯ 4.5 months (range, 0-14.2 months). Of 12 HeROs that functioned Ͼ30 days, average functional time has been 9 months. Two HeROs were removed for infection at 3.5 and 7.5 months after placement. Secondary patency was maintained in four patients for a mean duration of 10.4 Ϯ 4.9 months (range, 6.4-17.5 months), with an average of 4.0 Ϯ 2.2 thrombectomies (range, 1-6 months) per catheter.Conclusion...