Majdalany Bill S, Monfore Natosha, Khaja Minhaj S, Williams David M
Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
Cardiovasc Intervent Radiol. 2019 Jan;42(1):130-136. doi: 10.1007/s00270-018-2076-z. Epub 2018 Oct 4.
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 23-74 years (median 42 years) 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.
慢性闭塞的静脉支架可能难以挽救，需要多种方法和辅助技术。射频导丝已被用于在各种情况下穿过慢性阻塞病变。本文介绍了慢性闭塞静脉支架的射频导丝再通术（RFWR）。
15例患者（8例男性；7例女性），年龄23 - 74岁（中位年龄42岁），此前因静脉闭塞接受过静脉支架置入术。7例有潜在凝血功能障碍，3例有May-Thurner综合征，3例有诱因的深静脉血栓形成，1例有透析瘘，1例有原位起搏器导线。所有留置的静脉支架均为慢性闭塞且有症状。15例患者中，13例（87%）有髂股静脉支架，2例（13%）有上腔静脉和/或上肢静脉支架。在传统和钝性再通技术失败后，进行RFWR以穿过慢性阻塞病变。记录技术成功率和并发症情况。
15例患者接受了19次手术。12例患者接受了1次手术，2例患者接受了2次手术，1例患者接受了3次手术。19次手术中有12次（63%）单独使用RFWR，而19次中有7次（37%）需要辅助锐性再通技术。19次中有17次（89%）实现了技术成功或穿过闭塞病变并恢复通过闭塞段的血流。发生了1例严重并发症和1例轻微并发症。
射频导丝再通术是修订慢性闭塞静脉支架的有效辅助手段，可能提高具有挑战性病例的手术成功率。
