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

Abstract

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.

A case report of sharp recanalization in a hemodialysis patient with severe occlusion of both superior and inferior vena cave

“…Recently, using different methods and tools to cross the chronically occluded segments have been called sharp recanalization. The most common method for sharp recanalization uses a stiff guide wire, PTCD puncture needle, and RUPS100 and transseptal needle (1,7). Common complications in this type of surgical procedure include pain, bleeding associated with vein varicosities More severe complications include malignant arrhythmia, hydrothorax, hydropericardium, and especially pericardial tamponade, for which there is no efficient hemostasis method, posing a serious threat to life.…”

“…There are some studies have reported the techniques including sharp recanalization and puncture superior vena cave. However, the patients in these reports suffered from vascular occlusion either superior vena cava or brachiocephalic vein individually, while inferior vena cava is often spared entirely (1,2). But there are no reports of rebuilding vascular access in cases of multiple central vein occlusion involving the superior and inferior vena cava with the conditions occur bilaterally and the presence of severe edema.…”

Sharp recanalization for long-segment superior vena cava occlusion in a hemodialysis patient with vascular resource exhaustion: a case report

“…Transhepatic venipuncture and translumbar venipuncture are also treatment methods for refractory SVC obstruction, but have the disadvantages of poor tolerance and a high risk of infection. For patients refractory to conventional guidewire transversal, SVC sharp recanalization may be an option, and its application in SVC occlusion has been increasingly reported in recent years (3,4).…”

“…Patients with a CVC may experience endothelial inflammation, fibrosis, and thrombus formation due to blood flow disturbances and mechanical stimulation caused by the insertion of a hemodialysis catheter, leading to intimal hyperplasia and occlusion of the SVC lumen. If the position of the catheter tip proximal to the right atrium, it may develop chronic occlusion of the SVC, or SVC syndrome due to the above reaction (2,3). SVC occlusion can be treated via open surgical or endovascular repair.…”

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

“…However, it has been reported that refractory CVO cannot be recanalized using traditional catheter and guidewire techniques (7,8). Therefore, sharp recanalization with more procedure-related complications, such as a Chiba needle, the stiff end of a hydrophilic wire, and transseptal needle, has been gradually applied to the treatment of challenging CVO (9)(10)(11). Currently, blunt impingement for refractory CVO is rarely reported.…”