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Chun Yuet K, Lim D, Derek Chunyin H, Pei Shi L. Utility of the BeBack re-entry catheter to treat resistant cephalic arch occlusion in a haemodialysis patient: Case report and review of the literature. J Vasc Access 2025:11297298251322844. [PMID: 40012104 DOI: 10.1177/11297298251322844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2025] Open
Abstract
BACKGROUND Cephalic arch stenosis is a common complication in haemodialysis patients with brachiocephalic arteriovenous fistula (AVF) that can lead to access dysfunction. For resistant lesions that fail conventional endovascular treatment, a possible salvage approach to avoid open surgery is via sharp recanalization using re-entry catheters. METHODS We describe the unprecedented use of the BeBack re-entry catheter (Bentley InnoMed GmbH), previously the GoBack catheter (Upstream Peripheral Technologies), to overcome a recalcitrant cephalic arch occlusion by sharp recanalization in a 73-year-old female with thrombosed left brachiocephalic AVF that failed revascularization using conventional catheter and wire techniques. During the procedure, there was a contained perforation subcutaneously but the BeBack catheter was manoeuvred to re-enter into the axillary and subclavian vein. This was followed by balloon angioplasty and insertion of Viabahn (Gore Medical) stent grafts across the revascularized track. RESULTS Completion angiography at end of the procedure showed smooth flow through the cephalic system without subcutaneous extravasation and our patient avoided the need for open surgical bypass. No immediate postoperative complication was encountered. CONCLUSIONS Although the BeBack catheter has been predominantly used in difficult-to-treat lower limb chronic total occlusions, we have shown that it is also a potential feasible salvage option for sharp recanalization in the treatment of dysfunctional arteriovenous access.
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Affiliation(s)
- Khoo Chun Yuet
- Department of Vascular and Endovascular Surgery, Changi General Hospital, Singapore
| | - Darryl Lim
- Department of Vascular and Endovascular Surgery, Changi General Hospital, Singapore
| | - Ho Derek Chunyin
- Department of Vascular and Endovascular Surgery, Changi General Hospital, Singapore
| | - Lew Pei Shi
- Department of Vascular and Endovascular Surgery, Changi General Hospital, Singapore
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Rizk T, Gayed A, Stringfellow S, Younan Y, Yamada R, Guimaraes M. Review of Sharp Recanalization Techniques in Central Venous Occlusions. Cardiovasc Intervent Radiol 2024; 47:1626-1641. [PMID: 39080073 PMCID: PMC11621131 DOI: 10.1007/s00270-024-03789-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 06/10/2024] [Indexed: 12/06/2024]
Abstract
Benign central venous occlusions are frequently associated with long-term central venous access. Most of these occlusions can be recanalized with conventional endovascular technique. When conventional technique fails, sharp recanalization techniques (SRTs) can increase technical success. The SRTs include single low-profile needles, needle coaxial systems, re-entry catheter, the back end of stiff guidewires, and systems that can deliver radiofrequency energy or laser. This review on SRTs presents technical details and outcomes of the most common techniques used in central venous recanalization.
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Affiliation(s)
- Tony Rizk
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Antony Gayed
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Stringfellow
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Yara Younan
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Ricardo Yamada
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Marcelo Guimaraes
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, SC, USA.
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Liu Z, Tang Y, Huang J, Cao J, Huo G, Yao Z, Shen L, Zhou D. Efficacy and Safety of Sharp Recanalization with the Stiff End of a Microguidewire for Treatment of Refractory Central Venous Occlusions in Hemodialysis Patients. Ann Vasc Surg 2024; 98:398-405. [PMID: 37858667 DOI: 10.1016/j.avsg.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/22/2023] [Accepted: 08/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Sharp recanalization is a viable procedure for some refractory central venous occlusions that cannot be recanalized with the conventional technique. The sharp recanalization procedures reported in previous studies are often rely on costly devices and with a certain proportion of complications. This study aimed to present an inexpensive and risk-controllable coaxial centrifugally sharp recanalization technique that was independent of any additional costly devices. METHODS This retrospective study enrolled 8 patients who had received sharp recanalization of central venous occlusions, between August 2017 and May 2021. The sharp recanalization technique was performed centrifugally with the stiff end of a microguidewire after the lesions failed to be passed through with the conventional technique. Clinical data of patients on their lesions, technical success rate, procedure-related complications, and patency rates were collected and analyzed to assess the efficacy and safety of the technique. RESULTS Technical success was achieved in all patients, with no complications were observed. All symptoms were ameliorated within 48h postsurgery. The median follow-up period was 22 months. All patients maintained patency or assisted patency at 12 month follow-up. CONCLUSIONS Sharp recanalization performed centrifugally with the stiff end of the microguidewire could be a cost-effective and safe alternative procedure for the treatment of refractory central venous occlusion that cannot be recanalized with conventional technique.
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Affiliation(s)
- Zhanao Liu
- Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yao Tang
- Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jian Huang
- Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Junjie Cao
- Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Guijun Huo
- Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhichao Yao
- Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Liming Shen
- Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Dayong Zhou
- Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.
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Tabriz DM, Arslan B. Management of Central Venous Stenosis and Occlusion in Dialysis Patients. Semin Intervent Radiol 2022; 39:51-55. [PMID: 35210733 PMCID: PMC8856783 DOI: 10.1055/s-0041-1742152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Central venous occlusions (CVOs) of the major intrathoracic veins (jugular, subclavian, brachiocephalic, superior vena cava) can cause debilitating symptoms, negatively impact arteriovenous fistula/graft function, or limit potential access creation options in end-stage kidney disease (ESKD) utilizing hemodialysis (HD). This review summarizes the incidence, pathophysiology, indications/contraindications, and management options of CVOs in the ESKD on HD population and concludes with considerations and examples when planning endovascular central recanalization procedures, which have risen as the first-line management when appropriate.
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Affiliation(s)
- David M. Tabriz
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Bulent Arslan
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois,Address for correspondence Bulent Arslan, MD, FSIR Department of Vascular and Interventional Radiology, Rush University Medical Center1750 W. Harrison St. (Jelke), Suite 164, Chicago, IL 60612
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Wu XW, Zhao XY, Li X, Li JX, Liu ZY, Huang Z, Zhang L, Sima CY, Huang Y, Chen L, Zhou S. Effectiveness of sharp recanalization of superior vena cava-right atrium junction occlusion. World J Clin Cases 2021; 9:3848-3857. [PMID: 34141741 PMCID: PMC8180228 DOI: 10.12998/wjcc.v9.i16.3848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conventional recanalization techniques may fail in patients with completely occluded superior vena cava (SVC).
AIM To analyze the effectiveness and complications of sharp recanalization for completely occluded SVC.
METHODS This was a retrospective study of patients that underwent puncture and recanalization of the SVC between January 2016 and December 2017 at our hospital. Sharp recanalization was performed using the RUPS-100 system. The patients were followed for 12 mo. The main outcomes were the patency rate of SVC and arteriovenous fistula flow during dialysis.
RESULTS The procedure was successful in all 14 patients (100%). Blood pressure in the distal SVC decreased in all 14 cases (100%) from 26.4 ± 2.7 cmH2O to 14.7 ± 1.3 cmH2O (P < 0.05). The first patency rates of the SVC at 24 h and at 3, 6, 9 and 12 mo after sharp recanalization were 100%, 92.9%, 85.7%, 78.6% and 71.4%, respectively. There were two (14.3%) severe, one (7.1%) moderate and one (7.1%) minor complication. The severe complications included one case of pericardial tamponade and one case of hemothorax.
CONCLUSION The results suggest that sharp recanalization can be an additional tool to extend or renew the use of an occluded upper extremity access for hemodialysis. This could be of use in patients with long-term maintenance hemodialysis in whom the maintenance of central venous access is often a challenge.
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Affiliation(s)
- Xiao-Wen Wu
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Xu-Ya Zhao
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Xing Li
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Jun-Xiang Li
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Zong-Yang Liu
- Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Zhi Huang
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Ling Zhang
- Department of Nursing, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Chong-Yang Sima
- Department of Nephrology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Yu Huang
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Lei Chen
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang 550000, Guizhou Province, China
| | - Shi Zhou
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
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Long S, Sutphin PD, Kalva SP. Revascularization of Chronic Iliac Vein Occlusion Using Balloon-Assisted Transseptal Needle Puncture Technique. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1728996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Objectives To evaluate the utility of a transseptal needle for balloon-assisted sharp recanalization of chronically occluded central venous structures.
Background Chronically occluded central veins are not an uncommon problem, which may arise due to a plethora of reasons. Traditionally, wire and catheter techniques are often used first in an attempt to reestablish flow. When these methods fail, more aggressive techniques are employed, such as sharp recanalization using the back end of wires, Teflon-coated wires, or Rosch–Uchida or Colapinto needles. However, utilization of transseptal needles, traditionally reserved for cardiac procedures, has rarely been described.
Methods Transseptal needle was utilized for balloon-assisted sharp recanalization after traditional wire and catheter techniques failed in revascularization of chronically occluded iliac veins.
Results Transseptal needle was utilized successfully in two cases in revascularization of chronically occluded central veins.
Conclusion Transseptal needle is a viable tool to add to the interventional radiologists’ armamentarium in reestablishing flow in chronically occluded central veins.
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Affiliation(s)
- Simon Long
- Department of Vascular and Interventional Radiology, University of California Irvine, Orange, California, United States
| | - Patrick D. Sutphin
- Department of Vascular and Interventional Radiology, GRB-290 Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Sanjeeva P. Kalva
- Department of Vascular and Interventional Radiology, GRB-290 Massachusetts General Hospital, Boston, Massachusetts, United States
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Zhao Y, Lin F, Yang L, Qiao B, Wang Y, Yu Y, Cui T, Fu P. Sharp recanalization of the brachiocephalic vein occlusion through the external jugular vein in hemodialysis patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:640. [PMID: 32566577 PMCID: PMC7290652 DOI: 10.21037/atm-20-3015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Although the internal jugular vein (IJV) is the most widely used puncture site in hemodialysis catheter insertion and central vein angioplasty, the external jugular vein (EJV) offers an alternative vascular access point in cases when the IJV is inaccessible. The present study aims to observe the efficacy and safety of sharp recanalization of the brachiocephalic vein occlusion through the EJV in hemodialysis patients. Methods This retrospective study enrolled a cohort of hemodialysis patients who received sharp recanalization of occlusive brachiocephalic vein through the EJV at a university-affiliated hospital between January 2017 and January 2019. The demographic information and clinical outcome data of the patients were collected and analyzed. Results A total of 16 hemodialysis patients who received right brachiocephalic vein sharp recanalization through the EJV were analyzed. The technical success rate was 100%. Twelve patients (12/16, 75%), whose EJV-subclavian vein angle (E-S angle) was 60–80 degrees, were successfully recanalized on the first attempt. With the other 4 patients (4/16, 25%), whose E-S angle approached 90 degrees, the brachiocephalic vein was recanalized on the second attempt by elevating the ipsilateral shoulder, therefore decreasing the E-S angle to align the course of the EJV with the brachiocephalic vein. Three minor complications were recorded, including 1 patient with blood continuously oozing from the EJV at the puncture site and 2 patients with mild chest pain. After an average of 10 months of follow-up, the clinical patent rate was 81.25% with no procedure-related complications reported. Conclusions Sharp recanalization through the EJV could be an effective and safe alternative treatment for right brachiocephalic vein occlusion in hemodialysis patients if performed by an experienced practitioner. Measuring the angle formed by the EJV and the subclavian vein might provide helpful information for selecting patients.
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Affiliation(s)
- Yuliang Zhao
- Divison of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Feng Lin
- Department of Operations Management, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Letian Yang
- Divison of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Baiyu Qiao
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Yating Wang
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Yang Yu
- Divison of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Tianlei Cui
- Divison of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ping Fu
- Divison of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China
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Yang L, Yang L, Zhao Y, Wang Y, Yu Y, Salerno S, Li Y, Fu P, Cui T. The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study. Hemodial Int 2019; 24:52-60. [PMID: 31808994 DOI: 10.1111/hdi.12804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/25/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ling Yang
- Outpatient DepartmentWest China Hospital of Sichuan University Chengdu China
| | - Letian Yang
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Yuliang Zhao
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Yating Wang
- Department of Internal MedicineLouis A Weiss Memorial Hospital Chicago Illinois USA
| | - Yang Yu
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Stephen Salerno
- Department of BiostatisticsSchool of Public Health, University of Michigan Ann Arbor Michigan USA
| | - Yi Li
- Department of BiostatisticsSchool of Public Health, University of Michigan Ann Arbor Michigan USA
- Kidney Epidemiology and Cost CenterUniversity of Michigan Ann Arbor Michigan USA
| | - Ping Fu
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Tianlei Cui
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
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Success Rate and Complications of Sharp Recanalization for Treatment of Central Venous Occlusions. Cardiovasc Intervent Radiol 2017; 41:73-79. [PMID: 28879566 DOI: 10.1007/s00270-017-1787-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate success and safety of needle (sharp) recanalization as a method to re-establish access in patients with chronic central venous occlusions. MATERIALS AND METHODS Thirty-nine consecutive patients who underwent this procedure were retrospectively reviewed to establish success rate and associated complications. In all cases, a 21- or 22-gauge needle was used to restore connection between two chronically occluded segments after conventional wire and catheter techniques had failed. The needle was guided toward a target placed through a separate access by fluoroscopic guidance. When successful, the procedure was completed by placing a catheter, ballooning the segment, and/or stenting. RESULTS The procedure was successful in 37 of the 39 patients (95%). The vast majority of the treated lesions were in the SVC and/or right innominate vein. Occlusions ranged in length between 10 and 110 mm, and the average length of occluded venous segment was 40 mm in the treated group. There were four minor (SIR classification B) complications involving pain management after the procedure. There were two major (SIR classification D) complications both of which involved hemorrhage into the pericardium treated with covered stents (5.1%). CONCLUSIONS Sharp recanalization is a viable procedure for patients who have exhausted standard wire and catheter techniques. The operator performing this procedure should be familiar with potential complications so that they can be addressed urgently if needed.
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Arabi M, Ahmed I, Mat’hami A, Ahmed D, Aslam N. Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience. Cardiovasc Intervent Radiol 2015; 39:927-34. [DOI: 10.1007/s00270-015-1270-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
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