Safety and Effectiveness of Sharp Recanalization for Thoracic Central Venous Occlusion: A Systematic Review and...

To systematically review the literature on the effectiveness, safety, and long-term outcomes of sharp recanalization techniques for thoracic central venous occlusions (CVOs).

A search in Embase, Ovid MEDLINE, and Scopus databases, from inception until December 2023, was conducted using terms related to "recanalization" and "venous occlusion." A total of 4,979 records were identified and evaluated against the inclusion criteria. Data on technical success, patency rates, adverse events, and procedural details were extracted and analyzed as a pooled cohort. Statistical heterogeneity between studies was assessed using Cochran Q and I² statistics.

Twenty-eight studies with 521 patients were included. The most common indications for sharp recanalization included access for hemodialysis (n = 246, 47.2%) and symptomatic relief (n = 244, 46.8%). Occlusions were frequently located in the right brachiocephalic vein (25.9%). The most common instrument was some form of needle (20 studies, 71.4%), followed by stiff guide wires (8 studies, 81.6%). The pooled rates for various outcomes were 93.2% (95% CI, 90.7-95.0) for technical success, 65.1% (95% CI, 58.9-70.7) for primary patency rate, 90.9% (95% CI, 83.9-95.0) for secondary patency rate, and 15.9% (95% CI, 13.0-19.3) for adverse event rate. Most of the adverse events were mild (73.8%) with only 3 events categorized as life-threatening/disabling and 2 as fatal. Significant publication bias was found for technical success and adverse event rates, whereas no publication bias was found for primary patency rate.

Sharp recanalization techniques offer a valuable alternative for managing thoracic CVOs, especially when conventional endovascular approaches fail.