Keller Eric J, Gupta Suraj A, Bondarev Sergey, Sato Kent T, Vogelzang Robert L, Resnick Scott A
Division of Interventional Radiology, Northwestern University, 737 N. Michigan Ave., Suite 1600, Chicago, IL 60611.
Division of Interventional Radiology, Northwestern University, 737 N. Michigan Ave., Suite 1600, Chicago, IL 60611.
J Vasc Interv Radiol. 2018 Nov;29(11):1571-1577. doi: 10.1016/j.jvir.2018.06.017. Epub 2018 Oct 4.
To retrospectively review the effectiveness and safety of radiofrequency (RF) wire recanalization of refractory central venous occlusions (CVOs) and compare recurrent and nonrecurrent CVOs in terms of patient and occlusion characteristics.
Twenty CVOs were treated in 18 patients (age 40 y ± 13; 9 women) with 11 superior vena cava (SVC) or brachiocephalic vein occlusions (ie, supradiaphragmatic) and 9 inferior vena cava or iliac vein occlusions (ie, infradiaphragmatic). Indications included pain, edema, ulceration, and/or dialysis arteriovenous fistula dysfunction peripheral to the CVO(s). All patients had multiple venous thrombotic risk factors, including mechanical venous compression, endothelial injury, and/or coagulopathies. CVO traversal was first attempted with standard and advanced techniques before RF wire recanalization and followed up with computed tomographic venography and clinic visits approximately 1, 3, 6, and 12 months after treatment.
Sixteen CVOs (80%) were successfully transversed and associated with symptom relief. One major complication occurred involving SVC perforation into the pericardial space. Primary CVO patency rate was 56% at a median follow-up of 14.1 months (interquartile range [IQR], 9.2-20.0 mo). Recurrent CVOs tended to be infradiaphragmatic (71% vs 12% for supradiaphragmatic; P = .02), longer (12.9 cm ± 10.0 vs 2.3 cm ± 1.3; P < .01), and associated with implanted venous stents, filters, or cardiac pacer/defibrillator leads (86% vs 22%; P = .01). Median time to restenosis/occlusion was 1.5 months (IQR, 1.1-6.1 mo).
RF wire recanalization is a relatively effective and safe option for refractory CVOs. Patients with longer, infradiaphragmatic CVOs associated with indwelling devices may require closer follow-up for CVO recurrence.
回顾性分析射频（RF）导丝再通难治性中心静脉闭塞（CVO）的有效性和安全性，并比较复发性和非复发性CVO患者及闭塞特征。
18例患者（年龄40岁±13岁；9例女性）共20处CVO接受治疗，其中11处为上腔静脉（SVC）或头臂静脉闭塞（即膈上），9处为下腔静脉或髂静脉闭塞（即膈下）。适应证包括疼痛、水肿、溃疡和/或CVO周围的透析动静脉内瘘功能障碍。所有患者均有多种静脉血栓形成危险因素，包括机械性静脉压迫、内皮损伤和/或凝血障碍。在进行RF导丝再通之前，首先尝试用标准和先进技术穿过CVO，并在治疗后约1、3、6和12个月进行计算机断层静脉造影和临床随访。
16处CVO（80%）成功穿过并症状缓解。发生1例严重并发症，涉及SVC穿破进入心包腔。在中位随访14.1个月（四分位间距[IQR]，9.2 - 20.0个月）时，原发性CVO通畅率为56%。复发性CVO倾向于膈下病变（71%对膈上病变的12%；P = 0.02），更长（12.9 cm±10.0对2.3 cm±1.3；P < 0.01），且与植入的静脉支架、滤器或心脏起搏器/除颤器导线相关（86%对22%；P = 0.01）。再狭窄/闭塞的中位时间为1.5个月（IQR，1.1 - 6.1个月）。
RF导丝再通是难治性CVO的一种相对有效且安全的选择。与留置装置相关的较长的膈下CVO患者可能需要更密切随访以观察CVO复发情况。
