Radiofrequency wire \u2018power wire\u2019 recanalization of calcified chronically occluded inferior vena cava

Abhijit Salaskar,Michael Ferra,Anthony Venbrux,Daniel Scher,Albert Chun,Harish Narayanan,Shawn Sarin,Rishi Sood

doi:10.1186/s42155-018-0030-4

Abhijit Salaskar, Michael Ferra + Show 6 more

Open Access

https://doi.org/10.1186/s42155-018-0030-4

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Journal: CVIR endovascular	Publication Date: Nov 22, 2018
Citations: 5	License type: open-access

Affiliation: George Washington University Hospital

Abstract

BackgroundRadiofrequency (RF) wire recanalization of short segments of central venous obstruction has been considered safe; however its use for recanalization of long segments of inferior vena cava (IVC) has not been reported.Case presentationA 55-year-old female with recurrent massive hematemesis was found to have systemic venous upper esophageal varices on endoscopy and an extensive chronic IVC occlusion on CT. Using both a percutaneous transhepatic and transfemoral approach IVC recanalization was performed. A snare was advanced to the cavo-atrial junction via transhepatic venous access. From the groin utilizing RF wire steerable guide sheaths, endovascular reconstruction of the IVC was performed. Post recanalization venography demonstrated patent stented IVC and marked decrease in the intraabdominal-pelvic collaterals. No recurrence of hematemesis was noted. After 6 months, patient remained asymptomatic and had functioning right femoral arteriovenous hemodialysis graft.ConclusionsUsing appropriate techniques, Power wire recanalization of long occlusive segments of IVC can be safe and effective.

Highlights

Radiofrequency (RF) wire recanalization of short segments of central venous obstruction has been considered safe; its use for recanalization of long segments of inferior vena cava (IVC) has not been reported.Case presentation: A 55-year-old female with recurrent massive hematemesis was found to have systemic venous upper esophageal varices on endoscopy and an extensive chronic IVC occlusion on CT
RF wire was used for recanalization of short segments of occlusions within subclavian vein (SV), brachiocephalic vein (BV) and superior vena cava (SVC) (Guimaraes et al, 2012)
The IVC occlusion was successfully traversed with an RF wire and reconstructed with endovascular techniques after standard recanalization methods failed

Summary

Introduction

Radiofrequency (RF) wire recanalization of short segments of central venous obstruction has been considered safe; its use for recanalization of long segments of inferior vena cava (IVC) has not been reported.Case presentation: A 55-year-old female with recurrent massive hematemesis was found to have systemic venous upper esophageal varices on endoscopy and an extensive chronic IVC occlusion on CT. Conclusions: Using appropriate techniques, Power wire recanalization of long occlusive segments of IVC can be safe and effective. A patient who had repeated episodes of life threatening hematemesis from upper esophageal varices secondary to chronic occlusion of the SVC and IVC.

Results

Conclusion