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

• Published in: Cardiovascular and interventional radiology 2019-02, Vol.42 (2), p.205-212
• Main Authors: McDevitt, Joseph L., Srinivasa, Ravi N., Gemmete, Joseph J., Hage, Anthony N., Srinivasa, Rajiv N., Bundy, Jacob J., Chick, Jeffrey Forris Beecham
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; ANESTHESIA; Angioplasty; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - therapy; CARDIAC PACEMAKERS; Cardiology; Catheters; Chronic Disease; Clinical Investigation; Complications; COMPUTERIZED TOMOGRAPHY; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Etiology; Female; FLUOROSCOPY; Hemothorax; Humans; Hypodermic needles; Imaging; Implants; LUNGS; Male; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; MULTIVARIATE ANALYSIS; Needles; NEOPLASMS; Nuclear Medicine; Occlusion; Patients; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; Stents; Success; SURGERY; Surgical implants; Tamponade; Thorax; Thromboembolism; THROMBOSIS; Treatment Outcome; ULTRASONOGRAPHY; Ultrasound; Vascular Patency - physiology; VEINS; Veins & arteries; Venous Interventions; Young Adult
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-018-2090-1

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.