Sharp recanalization for treatment of central venous occlusive disease in hemodialysis patients

Abstract

Background:The purpose of the present study was to evaluate the technical feasibility and safety of sharp recanalization for central venous occlusive disease (CVOD) in patients requiring hemodialysis.Methods: Patients with CVOD requiring hemodialysis who had undergone endovascular recanalization using sharp devices, including the stiff end of a guidewire, Chiba needle, or RUS-100 to cross occluded segments after conventional techniques had failed were included. The needle was guided toward a target placed at the opposite end of the occlusion. Although the guidewire was passed though the occlusion, subsequent procedures such as percutaneous transluminal angioplasty could be performed.Results: A total of 27 sharp recanalization procedures in 25 patients were performed. Two attempts failed, 1 patient had undergone two separate successful procedures, and 23 procedures in 23 patients were successful. The overall technique success was 92.6%. The stiff end of a guidewire was the first choice for all the procedures, and recanalization was achieved in 18 patients (66.7%). A Chiba biopsy needle was used in six procedures (22.2%), with 100% technical success. A RUPS-100 set was used in two procedures (7.4%), with one aborted because of concern for complications. The occlusion was subsequently crossed using a Chiba needle. Four minor adverse events (two of mediastinal hematoma and two of chest pain) had occurred, and two major adverse events (pericardial tamponade and acute pleural effusion in one patient [4%], treated with the guidewire stiff-end technique, who recovered after drainage) had occurred.Conclusions: Sharp recanalization is safe and feasible with high technical success for CVOD in patients requiring hemodialysis who cannot be recanalized using conventional techniques.

Clinical Implications of Phenotypes of Hemodialysis Patients With Central Venous Occlusion or Central Venous Stenosis Defined by Cluster Analysis

“…The operation time of the sharp needle recanalization group (with an average operation time of 202.40 min in 10 patients) was significantly longer than that of the conventional method group (with an average operation time of 112.59 min in 81 patients) ( P < 0.001) as shown in Figure 6 . Besides, as our team has shown in previous studies, although sharp recanalization has high technical success in the recanalization of CVO/CVS in HD patients following failure of conventional recanalization, sharp needle recanalization is commonly used for lesions that cannot be recanalized by conventional techniques ( 14 – 17 ). The higher proportion of patients treated with sharp needle recanalization and a higher proportion of patients with technique failure in cluster 1 also indicate that CVO/CVS of patients in cluster 1 are more difficult to recanalize than that of cluster 2.…”

Endovascular Intravascular Intervention for Central Venous Stenosis in Maintenance Hemodialysis Patients: a Retrospective Observational Study

“…Gore & Associates, Flagstaff, AZ). The sharp recanalization technique can be used as an important supplement when the conventional blunt recanalization technique cannot cross the central vein occlusion [13,14,15] . Sharp recanalization refers to the use of the stiff end of the guidewire or the sharp interventional instrument directly through the vascular occlusion segment and then into the vascular lumen on the other side of the occlusion segment.…”

Superior Vena Cava Syndrome: An Update and Literature Review of Percutaneous Endovascular Treatments

“…Alternatively, sharp recanalization with a stiff end of a guidewire or 20-gauge Chiba Biopsy Needle (Cook Medical), or using a radiofrequency wire, such as the PowerWire RF Guidewire (Baylis Medical, Mississauga, Ontario, Canada), can be considered if the conventional recanalization is not successful. 29 Serious adverse events have been reported with this technique including transection of the SVC into the pericardium, resulting in cardiac tamponade. 1,30,31 Intravascular ultrasound may be utilized and is advised in severe stenoses or cases with thromboses.…”