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Sharp recanalization of central venous occlusions
T Farrell1, E V Lang, W Barnhart
1Department of Radiology, University of Iowa College of Medicine, Iowa City, USA.
Purpose:
To describe a sharp puncture technique for recanalization of chronic central venous occlusions that could not be traversed by a guide wire.
Materials And Methods:
Five patients presented with six longstanding central venous occlusions that could not be traversed with a guide wire after thrombolysis. The occlusions occurred following radiation for lung carcinoma (n = 2) and indwelling venous catheters (n = 4). The length of venous occlusion was determined by simultaneously advancing transbrachial and transfemoral catheters to the site of occlusion. Initially, a curved guiding catheter with a Rosch-Uchida needle and, in subsequent patients, a coaxial sheathed needle with a 21-gauge stylet were used for recanalization. The recanalized veins were then balloon dilated and stents were placed.
Results:
With use of this technique, recanalization was successful in five of the six occlusions. One occlusion was too long to traverse safely in one patient. Two patients were asymptomatic 16-18 months after the recanalization.
Conclusion:
This new technique offers an effective alternative to surgery in the treatment of central venous occlusion.