Sharp Recanalization of Symptomatic Chronic Central Venous Occlusions Using the Rösch-Uchida Transjugular Liver Access Set

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

DC

Dylan Constantino, MD (he/him/his)

Resident
University of Washington

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

MC

Maclean Cook, n/a

Medical Student
University of Washington
DS

David Shin, MD

Assistant Professor
University of Washington
MM

Mark Meissner, MD

Professor
University of Washington
MA

Matthew Abad-Santos, MD

Assistant Professor
University of Washington
Frederic Bertino, MD

Clinical Assistant Professor; Director of Pediatric Interventional Radiology
Department of Radiology at NYU Grossman School of Medicine
EM

Eric J. Monroe, MD

Associate Professor
University of Wisconsin
EH

Ethan Hua, MD

Assistant Professor
University of Washington
SV

Sandeep Vaidya, MBBS

Assistant Professor
University of Washington
Jeffrey F. Chick, MD, MPH

Vascular and Interventional Radiologist
University of Washington

Disclosure(s):

Dylan Constantino, MD: No financial relationships to disclose

Eric J. Monroe, MD: No financial relationships to disclose

Jeffrey F. Chick, MD, MPH: No relevant disclosure to display

Purpose: To report outcomes of sharp recanalization using the Rösch-Uchida Transjugular Liver Access (TIPS) Set (Cook Medical; Bloomington, Indiana) for the treatment of chronic central venous occlusions.

Materials and Methods: Thirty-one patients, including 22 (71.0%) men and nine (29.0%) women, with mean age of 49.1 ± 16.0 years (range: 23-77 years), underwent sharp recanalization using the Rösch-Uchida TIPS Set, between 05/2013 and 03/2022, after failed conventional recanalization. Etiologies of chronic venous occlusive disease included hypercoagulable disorders (10; 32.3%), long-term central venous access (5; 16.1%), trauma (5; 16.1%), stent occlusion (4; 12.5%), developmental anomalies (4; 12.9%), extrinsic compression (2; 6.5%), and long-dwelling inferior vena cava filter (1; 3.2%). Presenting symptoms included extremity pain and swelling (27; 73.0%), venous claudication (9; 29.0%), venous ulcers (7; 22.6%), varicosities (5; 16.1%), and facial plethora (1; 3.2%). Technical success, stent reconstruction parameters (stent number, type, and diameter), adverse events, clinical success, and patency rates were recorded. Technical success was defined as traversing the occluded venous segment. Clinical success was defined as improvement in presenting symptoms.

Results: Sites of chronic central venous occlusions included 30 (81.1%) in the abdomen and pelvis and seven (18.9%) within the thorax. Thirty-seven sharp recanalization attempts were performed. Technical success was achieved in 32/37 (86.5%) venous occlusions in 29/31 (93.5%) of patients. Stents were placed in 26/31 (83.9%) patients with a mean of 3.5 ± 2.1 stents per patient (range: 1-8 stents). Stent types included Wallstent (54; 59.3%), Abre (10; 11.0%), Zilver Vena (7; 7.7%),Viabahn (6; 6.6%), Z-stent (6; 6.6%), VBX (4; 4.3%), Venovo (2; 2.1%), Vici (1; 1.1%), and Smart stent (1; 1.1%). Mean diameter of stents was 15.8 ± 4.1-mm (range: 10-25 mm). Adverse events included superficial femoral artery-(SFA)-to femoral vein arteriovenous fistula with SFA pseudoaneurysm (n=1), hemopericardium (n=1), hemorrhagic shock (n=1), and one intraprocedural death of unknown etiology (n=1). Clinical success was reported in 24/31 (77.4%) patients. Primary and secondary stent patency rates at one year were 57% and 83.5% for the abdominopelvic recanalizations and 83% and 100% for the thoracic recanalizations, respectively.

Conclusion: Sharp recanalization utilizing the Rösch-Uchida TIPS Set offers a viable escalation technique for the recanalization of chronic central venous occlusions.