3:45 PMAbstract No. 317 - Radiofrequency wire recanalization of upper vs. lower central venous occlusions: technical success and strategies

Abstract

Chronic central venous occlusion is a source of significant morbidity. Occlusion traversal prior to definitive treatment is often difficult and occasionally unsuccessful with conventional methods. This study compares recanalization of upper (UCV) versus lower (LCV) central venous occlusions using a radiofrequency energy (RF) wire following failure of standard traversal methods. 13 patients with 14 central venous occlusions who failed aggressive conventional recanalization methods underwent repeat occlusion traversal attempt at a separate setting utilizing an RF wire between May 2014 and July 2016 at a single institution. Procedural details, technical success and clinical outcomes were compared between the UCV and LCV groups. 7 UCV occlusions involved the brachiocephalic veins and/or superior vena cava and 7 LCV occlusions involved the iliofemoral veins and/or inferior vena cava. Length of occlusion was significantly different in the UCV and LCV groups (median 1.5 vs. 9.3 cm respectively, p = 0.01). 7/7 UCV occlusions (100%) were successfully traversed and definitive angioplasty/stenting performed in 6/7 cases; 1 UCV procedure was terminated after occlusion traversal due to symptomatic pericardial entry beyond the occlusion. 5/7 (71%) LCV occlusions were successfully traversed and definite intervention was performed in 5/5 cases; 1 LCV procedure was aborted due to significant pain during RF wire activation at the occlusion site and another was technically unsuccessful due to calcified thrombus within the occluded segment. Clinical success was achieved in 11/11 (100%) cases with successful traversal and subsequent angioplasty/stenting, however in-stent restenosis was seen in 4/11 (36%) of these cases at follow-up; all were LCV occlusions (p = 0.02). RF wire recanalization is a useful technique for refractory chronic central venous occlusions with a high rate of technical success (86%). UCV occlusions were more often successfully traversed than LCV occlusions (100% vs. 71%). Challenges in UCV recanalization include avoidance of critical mediastinal structures, while challenges in LCV recanalization include longer length of occlusion and higher incidence of restenosis.