Use of a rosch-uchida needle for recanalization of refractory dialysis-related central vein occlusion.
OBJECTIVE
The purpose of this study was to evaluate our experience with the use of a Rösch-Uchida needle technique to recanalize central vein occlusion that cannot be traversed with a guidewire.


METHODS
We retrospectively evaluated 33 recanalization procedures performed with a Rösch-Uchida needle on 20 men and 13 women with central vein occlusion during the period January 1999-December 2008. The occlusions were in the subclavian vein (n = 29) and the brachiocephalic vein (n = 4). A 9- or 10-French Rösch-Uchida introducer sheath was advanced centrally to abut the occlusion. The Rösch-Uchida needle was directed and advanced toward a transfemoral angiographic catheter placed on the central side of the occlusion. After passage of a guidewire through the occlusion, balloon angioplasty and stent insertion were performed. The outcome measures evaluated were technical success rate, primary and secondary patency, and complication rate.


RESULTS
The mean occlusion length was 1.73 +/- 0.8 cm. The rate of technical success of recanalization was 93.9% (31 of 33 procedures). The 3-, 6-, and 12-month primary patency rates were 43.6%, 24%, and 8%, and the 3-, 6-, and 12-month secondary patency rates were 77.4%, 68.8% and 55.9%. One patient reported shoulder pain lasting 2 weeks, which resolved with conservative treatment.


CONCLUSIONS
Use of a Rösch-Uchida needle to recanalize central vein occlusion refractory to a traditional procedure is feasible and safe and can preserve the involved extremity for long-term hemodialysis.
Goo
Dong Erk
DE
Department of Radiology, Soonchunhyang University Hospital, 22 Daesagwan-gil, Yongsan-gu Seoul, 140-210, Republic of Korea. degoo@hosp.sch.ac.kr
Kim
Yong Jae
YJ
Choi
Deuk Lin
DL
Park
Sung Il
SI
Yang
Seung Boo
SB
Moon
Cheol
C
Song
Dan
D
D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects*; D015424:Reperfusion / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*