REGULAR CONTENT
Final ID
663
Type
Educational Exhibit-Poster Only
Authors
A Altman1, R Navuluri1, J Lorenz1
Institutions
1The University of Chicago, Chicago, IL
Purpose
After reviewing this exhibit, the reader should be able to recognize the options available for endovascular treatment of chronic central venous occlusions, including imaging findings, techniques, and differential applications.
Materials & Methods
Chronic central venous occlusion (CVO) can result from a number of pathologies, both benign and malignant. It is frequently encountered in patients with end stage renal disease undergoing hemodialysis, and is a significant source of patient morbidity and mortality. The incidence of CVO has been on the rise for the past decade, paralleling increased usage of tunneled central venous catheters and dialysis grafts. CVOs present challenging scenarios for interventional radiologists due to the dense intimal fibrosis associated with chronic occlusions which prevents passage of traditional hydrophilic catheters and guidewires.
Results
A variety of options exist for the treatment of CVO including use of hydrophilic guidewires, blunt dissecting and subintimal reentry catheters, sharp needles, and radiofrequency guidewires such as PowerWire™ (Baylis Medical, Montreal, QC Canada). Blunt dissecting catheters are designed to penetrate through dense fibrotic lesions, while subintimal reentry catheters bypass the occluded segment by exiting and re-entering the vascular lumen. Sharp needle technique involves the use of a sheathed TIPS needle or, alternatively, the stiff end of a glide wire to traverse the lesion. A number of instruments may be used as a target during recanalization including a guide wire, snare, balloon, or catheter. RF guidewires can be particularly useful for crossing long-segment, tortuous occlusions. Intra-procedural cone-beam CT is a useful adjunt by delineating anatomy and preventing penetration of neighboring arterial vessels and viscera.
Conclusions
A variety of new devices are now available for percutaneous treatment of chronic central venous occlusions. Imaging findings and techniques will be reviewed, with a focus on RF guidewires with and without cone-beam CT.
Final ID
663
Type
Educational Exhibit-Poster Only
Authors
A Altman1, R Navuluri1, J Lorenz1
Institutions
1The University of Chicago, Chicago, IL
Purpose
After reviewing this exhibit, the reader should be able to recognize the options available for endovascular treatment of chronic central venous occlusions, including imaging findings, techniques, and differential applications.
Materials & Methods
Chronic central venous occlusion (CVO) can result from a number of pathologies, both benign and malignant. It is frequently encountered in patients with end stage renal disease undergoing hemodialysis, and is a significant source of patient morbidity and mortality. The incidence of CVO has been on the rise for the past decade, paralleling increased usage of tunneled central venous catheters and dialysis grafts. CVOs present challenging scenarios for interventional radiologists due to the dense intimal fibrosis associated with chronic occlusions which prevents passage of traditional hydrophilic catheters and guidewires.
Results
A variety of options exist for the treatment of CVO including use of hydrophilic guidewires, blunt dissecting and subintimal reentry catheters, sharp needles, and radiofrequency guidewires such as PowerWire™ (Baylis Medical, Montreal, QC Canada). Blunt dissecting catheters are designed to penetrate through dense fibrotic lesions, while subintimal reentry catheters bypass the occluded segment by exiting and re-entering the vascular lumen. Sharp needle technique involves the use of a sheathed TIPS needle or, alternatively, the stiff end of a glide wire to traverse the lesion. A number of instruments may be used as a target during recanalization including a guide wire, snare, balloon, or catheter. RF guidewires can be particularly useful for crossing long-segment, tortuous occlusions. Intra-procedural cone-beam CT is a useful adjunt by delineating anatomy and preventing penetration of neighboring arterial vessels and viscera.
Conclusions
A variety of new devices are now available for percutaneous treatment of chronic central venous occlusions. Imaging findings and techniques will be reviewed, with a focus on RF guidewires with and without cone-beam CT.