Between march of 2022 and may of 2023,13 recanalization procedures for central vein occlusion were performed. Among the procedures, initial passage of a guidewire through an occlusion failed in 10 procedures on 10 patients. In these patients, recanalization was attempted with our modified technique, and these 10 patients constitute the sample for this study.

Technical Overview

All patients had a CT venogram performed for procedure planning. Superior (jugular/subclavian) and inferior (common femoral) venous accesses were secured with 6Fr femoral sheaths. Angiographic control was performed to locate the stenotic site, obtaining oblique views to plan the path for the guidewire to follow. Antegrade and retrograde passage of the occlusion was attempted with various 5-French angiographic catheters and 0.035-inch hydrophilic guidewires. If these attempts were unsuccessful, the femoral sheath was exchanged for a 10-French Rösch-Uchida introducer sheath (Cook) and the 14 gauge stiffening cannula was advanced up to the stenotic site; a diagnostic catheter was advanced through the superior access up to the obstruction and used as a marker. The stiffening cannula was aimed at the marker, with multiple oblique views performed to verify the position and path to be followed. Under fluoroscopic guidance, the stiff side of a  0.014” Command guidewire (Abbot) with a Rubicon 14 support catheter (Boston) was introduced through the Rösch-Uchida stiffening cannula and advanced through the occlusion. The guidewire was removed and angiographic control with the catheter was performed to verify intraluminal position. If the angiographic control showed that the catheter was not intraluminal, it was retracted and further attempts were performed. Once intraluminal location was evidenced,the guidewire was reinserted through the catheter, this time using the floppy side, and was captured with a snare and pulled out for through-and-through access. Angioplasty was performed with diverse balloon diameters. After angioplasty was performed, a self expandable stent was deployed to maintain patency. Angiographic controls were performed to evaluate revascularization. All patients received anticoagulation after the procedure for an indefinite period of time.

Technical success of the modified technique was defined as crossing of the stenosis site, with successful angiographic control proving endoluminal location of the catheter. Successful revascularization was defined as recanalization of the occluded central vein with residual stenosis of less than 30%.

Complications were classified according to the Society of Interventional Radiology.