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Cone-Beam CT and Image Fusion-Guided Percutaneous Recanalization of Occluded Central Venous Stent

Lamees I El Nihum1, M Mujeeb Zubair2, Ponraj Chinnadurai3,4

  • 1Texas A&M College of Medicine, Bryan, Texas, USA.

JACC. Case Reports
|December 17, 2021
PubMed

Insights

This case study presents a novel technique for recanalizing occluded central venous stents in patients with end-stage renal disease requiring dialysis access. The image fusion-guided approach offers a new solution for complex venous occlusions.

Area of Science:

  • Interventional Nephrology
  • Vascular Access Procedures
  • Medical Imaging Techniques

Background:

  • End-stage renal disease (ESRD) necessitates reliable vascular access for hemodialysis.
  • Central venous occlusions pose significant challenges for dialysis access creation and maintenance.
  • Limited options for vascular access increase patient morbidity and mortality.

Observation:

  • An 81-year-old male patient with ESRD presented with occlusion of the right subclavian and brachiocephalic veins.
  • The patient had exhausted other potential dialysis access sites.
  • A percutaneous recanalization procedure was planned using advanced imaging guidance.

Findings:

  • A novel percutaneous recanalization of the occluded right subclavian and brachiocephalic vein stent was successfully performed.
  • Image fusion guidance was utilized to navigate the complex venous anatomy and occluded stent.
  • The procedure restored patency to the central venous access, enabling future dialysis.

Implications:

  • This technique offers a potential solution for complex central venous occlusions in ESRD patients.
  • Image fusion guidance may improve procedural success rates in challenging vascular access interventions.
  • Expanding options for dialysis access can improve quality of life and outcomes for ESRD patients.

Keywords:
BCV, brachiocephalic veinCBCT, cone-beam computed tomographyCVO, central venous occlusionDSA, digital subtraction angiographyESRD, end-stage renal diseaseIJV, internal jugular veinLUE, left upper extremityMRV, magnetic resonance venographySCV, subclavian veinSVC, superior vena cavaTDC, tunneled dialysis cathetercentral venous occlusionimage fusionsharp needle recanalization

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