Central Venous Recanalization and Right Atrial Thrombectomy Using IVUS

Area of Science:

• Interventional Cardiology
• Vascular Surgery
• Medical Imaging

Background:

• Central venous occlusions (CVOs) cause significant morbidity, including venous congestion, thromboembolism, and impaired vascular access.
• Endovascular recanalization (EVR) is the primary treatment for refractory CVOs, with Intravascular Ultrasound (IVUS) increasingly vital.
• Traditional imaging lacks detailed intraluminal insights crucial for complex CVOs.

Purpose of the Study:

• To review the role and application of IVUS in guiding EVR for CVOs.
• To highlight IVUS's utility in evaluating pathology and procedural endpoints.
• To discuss the benefits of IVUS in reducing complications and improving success rates.

Main Methods:

• Utilizes radial and side-firing IVUS catheters for intraluminal imaging in the chest, abdomen, and pelvis.
• Employs IVUS to assess clot burden, wall integrity, tumor invasion, occlusion length, and luminal caliber.
• Guides EVR procedures including blunt/sharp recanalization, stenting, and mechanical thromboembolectomy (MTE).

Main Results:

• IVUS provides superior intraluminal visualization compared to venography or CT.
• IVUS accurately guides complex interventions like MTE for free-floating thrombi (FFT) and clot-in-transit (CIT).
• IVUS optimizes assessment of procedural success and reduces contrast/radiation exposure, particularly in hemodialysis patients.

Conclusions:

• IVUS is pivotal for accurate CVO evaluation and effective EVR guidance.
• Long-term data confirms IVUS enhances technical and clinical success while minimizing complications.
• Interventionalists must master IVUS techniques for optimal CVO treatment outcomes.