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

  • Clinical Investigation
  • Venous Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  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

    Joseph L. McDevitt

  2. Department of Interventional Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA

    Ravi N. Srinivasa

  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

    Joseph J. Gemmete, Rajiv N. Srinivasa & Jacob J. Bundy

  4. Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Philadelphia, PA, 19107, USA

    Anthony N. Hage

  5. Department of Cardiovascular and Interventional Radiology, INOVA Alexandria Hospital, 4320 Seminary Road, Alexandria, VA, 22304, USA

    Jeffrey Forris Beecham Chick

Authors
  1. Joseph L. McDevitt
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  2. Ravi N. Srinivasa
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  3. Joseph J. Gemmete
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  6. Jacob J. Bundy
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  7. Jeffrey Forris Beecham Chick
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Corresponding author

Correspondence to Jeffrey Forris Beecham Chick.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This study has obtained Institutional Review Board Approval, and the need for informed consent was waived.

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McDevitt, J.L., Srinivasa, R.N., Gemmete, J.J. et al. Approach, Technical Success, Complications, and Stent Patency of Sharp Recanalization for the Treatment of Chronic Venous Occlusive Disease: Experience in 123 Patients. Cardiovasc Intervent Radiol 42, 205–212 (2019). https://doi.org/10.1007/s00270-018-2090-1

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  • DOI: https://doi.org/10.1007/s00270-018-2090-1

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