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Cardiovasc Intervent Radiol. 2019 Feb;42(2):205-212. doi: 10.1007/s00270-018-2090-1. Epub 2018 Nov 20.

Approach, Technical Success, Complications, and Stent Patency of Sharp Recanalization for the Treatment of Chronic Venous Occlusive Disease: Experience in 123 Patients.

Author information

1
Department of Radiology, Division of Vascular and Interventional Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
2
Department of Interventional Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
3
Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
4
Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Philadelphia, PA, 19107, USA.
5
Department of Cardiovascular and Interventional Radiology, INOVA Alexandria Hospital, 4320 Seminary Road, Alexandria, VA, 22304, USA. jeffreychick@gmail.com.

Abstract

PURPOSE:

To report the technical success and complications following sharp recanalization of chronic venous occlusions.

MATERIALS AND METHODS:

A total of 123 patients, including 75 (61.0%) men and 48 (39.0%) women, with mean age of 50.5 ± 17.5 years (range 19-90 years), underwent sharp recanalization of chronic venous occlusions. The etiologies of occlusion were chronic deep venous thrombosis (n = 43; 35.0%), prior central venous access (n = 39; 31.7%), indwelling cardiac leads (n = 21; 17.1%), and occluded venous stents (n = 20; 16.3%). The sites of venous occlusion included 59/123 (48.0%) thoracic central veins, 37 (30.1%) non-thoracic central veins, and 27 (22.0%) peripheral veins. Median length of occlusion was 3.2 ± 1.4 cm (range 1.3-10.9 cm).

RESULTS:

Sharp recanalization was most commonly attempted with transseptal needles in 108/123 (87.8%), with a mean number of 1.2 ± 0.4 crossing devices per patient (range 1-4 devices). Targeting devices included a loop snare (n = 92; 74.8%), partially deployed Wallstent (n = 21; 17.1%), partially deployed Amplatzer vascular plug (n = 8; 6.5%), and an angioplasty balloon (n = 3; 2.4%). Technical success was achieved in 111 (90.2%) patients. There were 3 (2.4%) severe, 1 (0.8%) moderate, and 7 (5.7%) minor adverse events. Severe adverse events included 1 case each of pericardial tamponade, hemothorax, and inferior vena cava filter occlusion. 88 (71.5%) patients had venous stents placed; at the last follow-up examination, 68/86 (79.0%) stents were patent.

CONCLUSION:

Sharp recanalization has a high technical success and low rate of adverse events in the recanalization of chronic venous occlusions.

KEYWORDS:

Central venous occlusion; Chronic venous occlusion; Chronic venous occlusive disease; Sharp recanalization; Transseptal needle; Venous reconstruction

PMID:
30460385
DOI:
10.1007/s00270-018-2090-1
[Indexed for MEDLINE]

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