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

Eric J. Keller*, Suraj A. Gupta, Sergey Bondarev, Kent T Sato, Robert L Vogelzang, Scott A Resnick

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose: To retrospectively review the effectiveness and safety of radiofrequency (RF) wire recanalization of refractory central venous occlusions (CVOs) and compare recurrent and nonrecurrent CVOs in terms of patient and occlusion characteristics. Materials and Methods: Twenty CVOs were treated in 18 patients (age 40 y ± 13; 9 women) with 11 superior vena cava (SVC) or brachiocephalic vein occlusions (ie, supradiaphragmatic) and 9 inferior vena cava or iliac vein occlusions (ie, infradiaphragmatic). Indications included pain, edema, ulceration, and/or dialysis arteriovenous fistula dysfunction peripheral to the CVO(s). All patients had multiple venous thrombotic risk factors, including mechanical venous compression, endothelial injury, and/or coagulopathies. CVO traversal was first attempted with standard and advanced techniques before RF wire recanalization and followed up with computed tomographic venography and clinic visits approximately 1, 3, 6, and 12 months after treatment. Results: Sixteen CVOs (80%) were successfully transversed and associated with symptom relief. One major complication occurred involving SVC perforation into the pericardial space. Primary CVO patency rate was 56% at a median follow-up of 14.1 months (interquartile range [IQR], 9.2–20.0 mo). 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 (IQR, 1.1–6.1 mo). Conclusions: RF wire recanalization is a relatively effective and safe option for refractory CVOs. Patients with longer, infradiaphragmatic CVOs associated with indwelling devices may require closer follow-up for CVO recurrence.

Original languageEnglish (US)
Pages (from-to)1571-1577
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume29
Issue number11
DOIs
StatePublished - Nov 1 2018

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Superior Vena Cava
Brachiocephalic Veins
Iliac Vein
Defibrillators
Phlebography
Pericardium
Arteriovenous Fistula
Inferior Vena Cava
Ambulatory Care
Stents
Dialysis
Edema
Safety
Recurrence
Pain
Equipment and Supplies
Wounds and Injuries
Therapeutics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{6a492cf69ad04d9c952d7a0dff00f5cf,
title = "Single-Center Retrospective Review of Radiofrequency Wire Recanalization of Refractory Central Venous Occlusions",
abstract = "Purpose: To retrospectively review the effectiveness and safety of radiofrequency (RF) wire recanalization of refractory central venous occlusions (CVOs) and compare recurrent and nonrecurrent CVOs in terms of patient and occlusion characteristics. Materials and Methods: Twenty CVOs were treated in 18 patients (age 40 y ± 13; 9 women) with 11 superior vena cava (SVC) or brachiocephalic vein occlusions (ie, supradiaphragmatic) and 9 inferior vena cava or iliac vein occlusions (ie, infradiaphragmatic). Indications included pain, edema, ulceration, and/or dialysis arteriovenous fistula dysfunction peripheral to the CVO(s). All patients had multiple venous thrombotic risk factors, including mechanical venous compression, endothelial injury, and/or coagulopathies. CVO traversal was first attempted with standard and advanced techniques before RF wire recanalization and followed up with computed tomographic venography and clinic visits approximately 1, 3, 6, and 12 months after treatment. Results: Sixteen CVOs (80{\%}) were successfully transversed and associated with symptom relief. One major complication occurred involving SVC perforation into the pericardial space. Primary CVO patency rate was 56{\%} at a median follow-up of 14.1 months (interquartile range [IQR], 9.2–20.0 mo). 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 (IQR, 1.1–6.1 mo). Conclusions: RF wire recanalization is a relatively effective and safe option for refractory CVOs. Patients with longer, infradiaphragmatic CVOs associated with indwelling devices may require closer follow-up for CVO recurrence.",
author = "Keller, {Eric J.} and Gupta, {Suraj A.} and Sergey Bondarev and Sato, {Kent T} and Vogelzang, {Robert L} and Resnick, {Scott A}",
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Single-Center Retrospective Review of Radiofrequency Wire Recanalization of Refractory Central Venous Occlusions. / Keller, Eric J.; Gupta, Suraj A.; Bondarev, Sergey; Sato, Kent T; Vogelzang, Robert L; Resnick, Scott A.

In: Journal of Vascular and Interventional Radiology, Vol. 29, No. 11, 01.11.2018, p. 1571-1577.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Single-Center Retrospective Review of Radiofrequency Wire Recanalization of Refractory Central Venous Occlusions

AU - Keller, Eric J.

AU - Gupta, Suraj A.

AU - Bondarev, Sergey

AU - Sato, Kent T

AU - Vogelzang, Robert L

AU - Resnick, Scott A

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Purpose: To retrospectively review the effectiveness and safety of radiofrequency (RF) wire recanalization of refractory central venous occlusions (CVOs) and compare recurrent and nonrecurrent CVOs in terms of patient and occlusion characteristics. Materials and Methods: Twenty CVOs were treated in 18 patients (age 40 y ± 13; 9 women) with 11 superior vena cava (SVC) or brachiocephalic vein occlusions (ie, supradiaphragmatic) and 9 inferior vena cava or iliac vein occlusions (ie, infradiaphragmatic). Indications included pain, edema, ulceration, and/or dialysis arteriovenous fistula dysfunction peripheral to the CVO(s). All patients had multiple venous thrombotic risk factors, including mechanical venous compression, endothelial injury, and/or coagulopathies. CVO traversal was first attempted with standard and advanced techniques before RF wire recanalization and followed up with computed tomographic venography and clinic visits approximately 1, 3, 6, and 12 months after treatment. Results: Sixteen CVOs (80%) were successfully transversed and associated with symptom relief. One major complication occurred involving SVC perforation into the pericardial space. Primary CVO patency rate was 56% at a median follow-up of 14.1 months (interquartile range [IQR], 9.2–20.0 mo). 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 (IQR, 1.1–6.1 mo). Conclusions: RF wire recanalization is a relatively effective and safe option for refractory CVOs. Patients with longer, infradiaphragmatic CVOs associated with indwelling devices may require closer follow-up for CVO recurrence.

AB - Purpose: To retrospectively review the effectiveness and safety of radiofrequency (RF) wire recanalization of refractory central venous occlusions (CVOs) and compare recurrent and nonrecurrent CVOs in terms of patient and occlusion characteristics. Materials and Methods: Twenty CVOs were treated in 18 patients (age 40 y ± 13; 9 women) with 11 superior vena cava (SVC) or brachiocephalic vein occlusions (ie, supradiaphragmatic) and 9 inferior vena cava or iliac vein occlusions (ie, infradiaphragmatic). Indications included pain, edema, ulceration, and/or dialysis arteriovenous fistula dysfunction peripheral to the CVO(s). All patients had multiple venous thrombotic risk factors, including mechanical venous compression, endothelial injury, and/or coagulopathies. CVO traversal was first attempted with standard and advanced techniques before RF wire recanalization and followed up with computed tomographic venography and clinic visits approximately 1, 3, 6, and 12 months after treatment. Results: Sixteen CVOs (80%) were successfully transversed and associated with symptom relief. One major complication occurred involving SVC perforation into the pericardial space. Primary CVO patency rate was 56% at a median follow-up of 14.1 months (interquartile range [IQR], 9.2–20.0 mo). 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 (IQR, 1.1–6.1 mo). Conclusions: RF wire recanalization is a relatively effective and safe option for refractory CVOs. Patients with longer, infradiaphragmatic CVOs associated with indwelling devices may require closer follow-up for CVO recurrence.

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