Radiofrequency Wire Recanalization of Chronically Occluded Venous Stents: A Retrospective, Single-Center Experience in 15 Patients.

Abstract

Chronically occluded venous stents may be difficult to salvage, necessitating multiple approaches and adjunctive techniques. Radiofrequency wires have been used to cross chronic obstructions in a variety of settings. Herein, radiofrequency wire recanalization (RFWR) of chronically occluded venous stents is presented. Fifteen patients (8 males; 7 females) aged 23-74years (median 42years) underwent prior venous stenting in the setting of venous occlusions. Seven had an underlying coagulopathy, three had May-Thurner syndrome, three had provoked deep venous thrombosis, one had a dialysis fistula, and one had pacer leads in situ. All indwelling venous stents were chronically occluded and symptomatic. Out of 15 patients, 13 (87%) had iliocaval venous stents, while two (13%) had superior vena cava and/or upper extremity venous stents. After failing conventional and blunt recanalization techniques, RFWR was performed to traverse the chronic occlusions. Technical success and complications were recorded. Fifteen patients underwent 19 procedures. Twelve patients underwent one procedure, two patients had two procedures, and one patient had three procedures. RFWR alone was used in 12/19 (63%) procedures, while 7/19 (37%) required adjunctive sharp recanalization techniques. Technical success or crossing of the occlusion with flow restoration through the occluded segments was achieved in 17/19 (89%). One major and one minor complication occurred. Radiofrequency wire recanalization is an effective adjunct to revise chronically occluded venous stents, potentially increasing procedural success in challenging cases.