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IP249. Improved Percutaneous Central Venous Recanalization Rates With Novel Telescoping Catheter System

2016; Elsevier BV; Volume: 63; Issue: 6 Linguagem: Inglês

10.1016/j.jvs.2016.03.162

1097-6809

Tony Lu, Adeline Schwein, Carlos F. Bechara, Jean Bismuth,

Diagnosis and Treatment of Venous Diseases

Endovascular intervention is the mainstay of therapy for central venous occlusive disease (CVOD). Hydrophilic wires and guidecatheters have traditionally been used, with traversal rates ranging from 50% to 93% in the literature depending largely on the chronicity of the lesion and degree of sclerosis. The Cook Medical TriForce Peripheral Crossing Set is a reinforced, telescoping catheter system available in multiple configurations that has been designed for greater penetration and pushability. The aim of this study is to evaluate our recanalization results with traditional endovascular tools and the new catheter system. This is a single-center retrospective, nonrandomized study at a quaternary referral center between January and December 2015. Standard fluoroscopy and digital subtraction angiography were used to guide diagnosis and treatment. Devices and vascular access were selected based on physician preference. The number of involved vascular segments was determined radiographically based on the number of occluded, named vessels. Each operative procedure was counted as a recanalization attempt. The primary end point was radiographic recanalization of the occluded venous segment (s). Secondary end points included fluoroscopy time and total radiation dose. Thirty-seven consecutive patients with a mean age of 49 ± 2.4 years were treated over the study period (Table I). Major comorbidities included end-stage renal disease (65%), deep venous thrombosis (30%), hypercoagulable state (8%), and May-Thurner syndrome (5%). The majority presented with chronic extremity edema (78%), pain (35%), or facial swelling (30%). Forty attempts were made with traditional catheters/wires and 16 attempts with TriForce to treat 2.1 ± 0.2 and 1.9 ± 0.3 occluded segments, respectively (P = .76). Traditional techniques succeeded in 40% and TriForce in 75% of cases (P = .04). Four of 6 patients (67%) were successfully recanalized with the TriForce after initial failure with traditional endovascular tools. Mean fluoroscopy time and radiation dose were 30 ± 6.1 minutes and 15,137 ± 10,433 μGy × m2 for traditional techniques vs 12 ± 2.3 minutes and 30,408 ± 3207 μGy × m2 for the TriForce (P = .01 and P = 0.18, respectively). The new catheter system is a useful adjunct that may increase the recanalization rate and decrease fluoroscopy time in CVOD while maintaining similar radiation exposure.TablePatient demographics and resultsNo. or mean ± SD (n = 37)P valueAge, years49 ± 2.4Male23Body mass index, kg/m231 ± 1.4Comorbidities End-stage renal disease24 Deep venous thrombosis11 Hypercoagulable state3 May-Thurner syndrome2Symptoms Extremity edema29 Pain13 Facial swelling11 Paresthesia2 Arteriovenous access malfunction7Symptom onset <2 weeks8 ≥2 weeks24 Unknown5Average No. of involved segments Traditional2.1 ± 0.2.76 TriForce1.9 ± 0.3Recanalization attempts Traditional40 TriForce16Successful recanalizations Traditional16.04 TriForce12Average fluoroscopy time, min Traditional30 ± 6.1.01 TriForce12 ± 2.3Average radiation dose, μGy × m2 Traditional15,136.9 ± 10,432.8.18 TriForce30,408.3 ± 3207.2SD, Standard deviation. Open table in a new tab