title: Sharp central venous recanalization by means of a TIPS needle.
abstract: The purpose of this study was to perform an alternative technique for recanalization of a chronic occlusion of the left brachiocephalic vein that could not be traversed with a guidewire. Restoration of a completely thrombosed left brachiocephalic vein was attempted in a 76-year-old male hemodialysis patient with massive upper inflow obstruction, massive edema of the face, neck, shoulder, and arm, and occlusion of the stented right brachiocephalic vein/superior vena cava. Vessel negotiation with several guidewires and multipurpose catheters proved unsuccessful. The procedure was also non-viable using a long, 21 G puncture needle. Puncture of the superior vena cava (SVC) at the distal circumference of the stent in the right brachiocephalic vein/superior vena cava, however, was feasible with a transjugular intrahepatic portosystemic shunt (TIPS) set under biplanar fluoroscopy using the distal end of the right brachiocephalic vein as a target, followed by balloon dilatation and partial extraction of thrombotic material of the left brachiocephalic vein with a wire basket. Finally, two overlapping stents were deployed to avoid early re-occlusion. Venography demonstrated complete vessel patency with free contrast media flow via the stents into the SVC, which was reconfirmed in follow-up examinations. Immediate clinical improvement was observed. Venous vascular recanalization of chronic venous occlusion by means of a TIPS needle is feasible as a last resort under certain precautions.
authors.affiliation: Department of Diagnostic Radiology, University Hospital, Aachen, Germany. honnef@rad.rwth-aachen.de
authors.forename: Dagmar
authors.initials: D
authors.lastname: Honnef
authors.forename: Markus
authors.initials: M
authors.lastname: Wingen
authors.forename: Rolf W
authors.initials: RW
authors.lastname: Günther
authors.forename: Patrick
authors.initials: P
authors.lastname: Haage
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000379:methods*; D006801:Humans; D007601:Jugular Veins / Q000473:pathology / Q000601:surgery; D008297:Male; D009339:Needles; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation* / Q000379:methods*; D013350:Subclavian Vein / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014683:Vena Cava, Superior / Q000473:pathology / Q000601:surgery; D020246:Venous Thrombosis / Q000601:surgery