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Monday, November 19, 2018

Single-Center Retrospective Review of Radiofrequency Wire Recanalization of Refractory Central Venous Occlusions 


Summary


Recent retrospectively study reviewed the effectiveness and safety of radiofrequency (RF) wire recanalization of central venous occlusions (CVOs) and compared recurrent and nonrecurrent CVOs in terms of patient and occlusion characteristics. A total of twenty CVOs were treated in 18 patients including the superior vena cava (SVC), brachiocephalic veins, inferior vena cava and iliac veins. CVO traversal was first attempted with standard and advanced techniques before RF wire recanalization. Sixteen CVOs (80%) were successfully transversed and associated with symptom relief. SVC perforation into the pericardial space occurred in one patient, who recovered completely from the procedure. Primary CVO patency rate was 56% at a median follow-up of 14.1 months. Recurrent CVOs tended to be infradiaphragmatic (71% vs 12% for supradiaphragmatic; P = .02), longer (12.9 cm ± 10.0 vs 2.3 cm ± 1.3; P < .01), and associated with implanted venous stents, filters, or cardiac pacer/defibrillator leads (86% vs 22%; P = .01). Median time to restenosis/occlusion was 1.5 months. Follow-up with computed tomographic venography and clinic visits was performed approximately 1, 3, 6, and 12 months after treatment. The authors concluded that RF wire recanalization is a relatively effective and safe option for refractory CVOs. Longer, infradiaphragmatic CVOs associated with indwelling devices may require closer follow-up for CVO recurrence.



Figure 2. Recanalization of a refractory CVO involving a left common iliac vein stent in a 28-year-old woman with May–Thurner syndrome, an IVC filter, and multiple endovenous interventions. (a,b) Venograms from an outside hospital at which standard recanalization from caudal and cranial approaches had failed. (c) Advancement of an angled RF wire into the occlusion. (d) Posttreatment venogram shows resolution of the CVO.

Commentary


This paper presents further understanding of this previously described technique of sharp recanalization of CVO utilizing RF wire. We are all aware of the increasing incidence of CVO and how debilitating it can be to the patients. In addition, treatment of this condition is very challenging and pretty much limited to endovascular recanalization. In the present study the majority of the patients (80%) had technical and clinical success with only one major complication (SVC perforation) that resolved completely without further intervention. Infradiaphragmatic occlusions (iliac/IVC), longer occluded segments and presence of implanted devices (previous stents, IVC filter, defibrillator/pacemaker leads) were associated with higher incidence of recurrent stenosis/occlusion. As mentioned by the authors the study is limited by the small sample size and by the fact that all procedures were performed by a single operator, which may prevent reproducibility. Nonetheless, the research adds new knowledge regarding patient and lesion characteristics that may influence the outcome. This will certainly help interventionalists in their decision making process and to tailor more appropriate care for each patient. The study also highlights the need for further investigation on other methods of CVO recanalization and their potential associated predictive factors for recurrent stenosis/occlusion.

Keller EJ, Gupta SA, Bondarev S, Sato KT, Vogelzang RL, Resnick SA. Single-Center Retrospective Review of Radiofrequency Wire Recanalization of Refractory Central Venous Occlusions. Journal of Vascular and Interventional Radiology. 2018 Nov 1;29(11):1571-7.

Click here for abstract

Post Author:
Ricardo Yamada, MD
Assistant Professor
Department of Radiology
Division of Vascular and Interventional Radiology
Medical University of South Carolina

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