Recanalization of complete central venous occlusion using the kissing-wire and wire tensioning techniques: A case...

Central venous occlusion (CVO) is a common and serious complication in patients undergoing maintenance hemodialysis (MHD). A 62-year-old male on maintenance hemodialysis for 20 years was admitted with right upper limb swelling that had persisted for 2 years and had markedly worsened over the preceding 2 months. Physical examination revealed pronounced swelling of the right upper limb, accompanied by localized skin hyperpigmentation. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) of the right upper extremity demonstrated complete occlusion of the right subclavian and innominate veins, with an occlusion length of approximately 6.5 cm. The occluded segment was successfully crossed using the kissing-wire and wire tensioning techniques. Subsequently, sequential balloon dilation was performed, followed by implantation of a 10 mm × 100 mm covered stent (Bard, Fluency Plus). Postoperative angiography demonstrated complete recanalization of the occluded vessel, with marked improvement in arteriovenous fistula blood flow. At the 3-month follow-up, no restenosis was observed. This case demonstrates that the combined use of kissing-wire and wire tensioning techniques for hemodialysis-related central venous occlusion is feasible and provides a valuable technical option for the endovascular management of complex central venous occlusions.