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Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach.

Publication ,  Journal Article
Gallo, CJR; Ronald, J; Pabon-Ramos, WM; Suhocki, PV; Sag, AA; Martin, JG; Smith, TP; Kim, CY
Published in: Cardiovasc Intervent Radiol
May 2021

PURPOSE: To evaluate the technical success and safety of a steerable coaxial sharp recanalization technique that utilizes routine needles in patients with refractory thoracic central venous occlusions. MATERIALS AND METHODS: This retrospective study was performed on 36-attempted sharp recanalizations in 35 patients (mean age 50 years, 23 male) performed via a supraclavicular approach. In all cases, an 18-gauge trocar needle was custom curved to provide directional control during fluoroscopic triangulation. A 22-gauge Chiba needle was then advanced coaxially across the occlusion. A tractogram was performed to assess for traversal of unintended structures. Procedures were completed by catheter placement, angioplasty, or stenting follow successful recanalizations. RESULTS: Sharp recanalization using this steerable coaxial needle technique demonstrated a technical success rate of 94% (34/36). The mean occlusion length was 30 mm (range 3-53 mm). In 11 patients, success was achieved using this technique after failure of other advanced techniques. In five procedures, stent interstices were traversed. Sharp recanalization was the direct cause of one major complication consisting of pleural transgression causing mild hemothorax treated successfully with a stent graft. CONCLUSION: The proposed technique is effective and safe for patients who have failed traditional blunt recanalization techniques. LEVEL OF EVIDENCE: Level 4, Case Series.

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Published In

Cardiovasc Intervent Radiol

DOI

EISSN

1432-086X

Publication Date

May 2021

Volume

44

Issue

5

Start / End Page

784 / 788

Location

United States

Related Subject Headings

  • Vascular Diseases
  • Treatment Outcome
  • Thorax
  • Stents
  • Retrospective Studies
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

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Gallo, C. J. R., Ronald, J., Pabon-Ramos, W. M., Suhocki, P. V., Sag, A. A., Martin, J. G., … Kim, C. Y. (2021). Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach. Cardiovasc Intervent Radiol, 44(5), 784–788. https://doi.org/10.1007/s00270-020-02728-7
Gallo, Christopher J. R., James Ronald, Waleska M. Pabon-Ramos, Paul V. Suhocki, Alan A. Sag, Jonathan G. Martin, Tony P. Smith, and Charles Y. Kim. “Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach.Cardiovasc Intervent Radiol 44, no. 5 (May 2021): 784–88. https://doi.org/10.1007/s00270-020-02728-7.
Gallo CJR, Ronald J, Pabon-Ramos WM, Suhocki PV, Sag AA, Martin JG, et al. Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach. Cardiovasc Intervent Radiol. 2021 May;44(5):784–8.
Gallo, Christopher J. R., et al. “Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach.Cardiovasc Intervent Radiol, vol. 44, no. 5, May 2021, pp. 784–88. Pubmed, doi:10.1007/s00270-020-02728-7.
Gallo CJR, Ronald J, Pabon-Ramos WM, Suhocki PV, Sag AA, Martin JG, Smith TP, Kim CY. Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach. Cardiovasc Intervent Radiol. 2021 May;44(5):784–788.
Journal cover image

Published In

Cardiovasc Intervent Radiol

DOI

EISSN

1432-086X

Publication Date

May 2021

Volume

44

Issue

5

Start / End Page

784 / 788

Location

United States

Related Subject Headings

  • Vascular Diseases
  • Treatment Outcome
  • Thorax
  • Stents
  • Retrospective Studies
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Humans
  • Female