Recanalization of occluded central veins in hemodialysis patients using a dual lumen microcatheter.

Abstract

Percutaneous transluminal angioplasty (PTA) is the standard therapy for stenosis or occlusion of the central vein in patients with chronic kidney disease undergoing routine hemodialysis. In the case of chronic total occlusion (CTO) of the central vein, crossing the lesion might be the most challenging part of the procedure. Although several techniques have been successfully used, a new, additional strategy that is safer yet equally effective would be beneficial. We reported two cases of central vein occlusion in which the lesions could not be crossed by multiple escalating wires even with the support of a microcatheter. The wires could not penetrate the hardest part of the lesion and were always deflected to the false route. A dual lumen microcatheter was used as a support for the first wire and to facilitate the insertion of a second wire through the chronic occlusion. The dual lumen microcatheter successfully facilitated wire crossing of the CTO lesion in two patients. Dual lumen microcatheters may serve as an alternative strategy to cross central vein occlusions during PTA.