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Abstract No. 641 Safety and efficacy of using telescoping CTO devices for complex chronic occlusions in SVC syndrome

2018; Elsevier BV; Volume: 29; Issue: 4 Linguagem: Inglês

10.1016/j.jvir.2018.01.686

1535-7732

K. Zhang, Brian F. McCabe, Charbel Ishak, Rakesh Ahuja, Paul S. Brady, Sreya Doddakashi,

Central Venous Catheters and Hemodialysis

Evaluate efficacy and safety of telescoping CTO devices for recanalizing chronic advanced central vein occlusion in SVC syndrome patients where previous attempts have failed. Multicenter retrospective review of 12 patients from 2015-2017 were performed. All procedures were performed by a single operator and 8 patients have failed previous attempts to recanalization while 4 patients had extensive attempt in the same session using other techniques before using CTO devices. Any potential complications such as bleeding, infection, and stent migration were reviewed. All procedures were performed through right common femoral vein access using an 6 French 70cm Sheath whose tip was placed in the distal SVC. Recanalization was performed by using weighted tip 0.018 inch wire in conjunction with a 0.018 crossing catheter inside of a supporting catheter. Angled crossing and supporting catheter were used in 4 patients who had brachiocephalic occlusions. All patients underwent angioplasty and stenting of the occluded segment. 7 Patients required body-flossing 2nd access site from the internal jugular vein. Patients were seen 3 days after procedure to assess clinical outcome and potential complications. Average follow-up time is 102 days. During a period of 1.8 years, 12 patients (age range 52-76 years, mean age 58 years) were treated percutaneously for significant non-tumoral SVC syndrome. All recanalization attempts using CTO device were successful angiographically. All 12 patients had near complete resolution of swelling on 3 day follow-up as well as long-term follow-up averaging 103 days post op. Average procedure time was 54 minutes; average fluoroscopy time was 24 minutes. There were no bleeding complications, no infection, no stent migration, no inadvertent perforation into the arterial system. There were 2 patients had insignificant soft tissue extravasation/venous perforation with 0.018 wire. Using telescoping CTO technique for difficult to treat chronic central venous occlusion is a safe and effective approach in patient with SVC syndrome with good clinical outcome. It also shortens procedure time compared to conventional techniques.Tabled 1Types of Occlusion#PtTypes of Devices UsedComplicationsAveFollow-up Time (days)# Successful OutcomeAverage Fluoroscopy Time (min)# Needed 2nd Body Flossing Access SiteLeft brachial cephalic occlusion only42 Angled Triforce2 Angled Navicross+Quickcross2 with insignificant soft tissue extravasation844424SVC and left brachial cephalic occlusion22 Angled Navicross+Quickcross01332222SVC occlusion only64 Angled Triforce. 2 Angled Navicross+Quickcross3 with insignificant soft tissue extravasation1066132 Open table in a new tab