title: The feasibility and safety of a through-and-through wire technique for central venous occlusion in dialysis patients.
abstract: To retrospectively compare the operation time, success rate and efficacy between unidirectional and bidirectional procedures in the treatment of central venous occlusion diseases (CVOD), assess the advantages of the bidirectional approach, and determine the characteristics of CVOD appropriate for the bidirectional approach treatment.
  
  
  
  A total of 49 patients who underwent endovascular interventions with all relevant data between January 2011 and December 2015 at the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, were included in this retrospective study, and were categorized into two groups: the 19 patients in group 1 had undergone percutaneous transluminal venoplasty (PTV) via a conventional technique (unidirectional procedure from the vein distal or proximal to the obstructive lesion), and the 30 in group 2 had undergone flossing wire technique (bidirectional procedure from femoral vein and the vein distal to obstructive lesion and using a flossing wire technique). The technical success rate, the fluoroscopy time in the procedure, perioperative complications, and patency were evaluated retrospectively.
  
  
  
  Compared with group 1, group 2 had a higher initial technical success rate (83.33% vs. 47.36%, p = 0.012) but a shorter fluoroscopy time (82.6 ± 26.1 vs. 116.1 ± 42.1, p = 0.048). Receiver operating characteristic (ROC) analysis indicated that a lesion with a length of 6.5 cm was the best predictor of technique success (p = 0.02) in group 1, but no cut-off value was identified for group 2. There were no significant differences in perioperative complications between these two groups. The complication rates were 31.58% (6/19) in group 1 and 6.67% (2/30) in group 2, (p = 0.043), respectively. No significant difference was observed between these two groups with respect to the stent patency rate.
  
  
  
  Compared with the conventional technique, the flossing wire technique has a higher success rate, shorter fluoroscopy time, fewer complications and similar patency rate. It is a feasible treatment for CVOD, especially for long obstructive lesions.
authors.affiliation: The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China. cir.huangyonghui@vip.163.com.
authors.forename: Yonghui
authors.initials: Y
authors.lastname: Huang
authors.affiliation: The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Chen
authors.affiliation: The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
authors.forename: Guosheng
authors.initials: G
authors.lastname: Tan
authors.affiliation: The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Cheng
authors.affiliation: The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
authors.forename: Jiaping
authors.initials: J
authors.lastname: Li
authors.affiliation: The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China. cjr.yangjianyong@vip.163.com.
authors.forename: Jianyong
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents; D062666:Vascular Access Devices / Q000009:adverse effects*; D014654:Vascular Patency
keywords: Central venous occlusion disease; Endovascular intervention; Hemodialysis; Stent; Though-and-through