SAN FRANCISCO—A radiofrequency (RF) wire technique appears to be a safe alternative for managing benign chronic central venous occlusions when conventional techniques have failed, according to findings presented at the 37^th Annual Scientific Meeting of the Society of Interventional Radiology.

“We have been the pioneers on this,” stated study investigator Marcelo Guimaraes, MD, Associate Professor of Radiology at the Medical University of South Carolina in Charleston.  “We have been doing this now for three years and we have the largest experience in the world with this procedure. We only treat symptomatic patients or patients who are on dialysis and the AV [arteriovenous] graft or fistula is showing malfunction.”

Dr. Guimaraes and his colleagues analyzed the outcomes of 31 patients (15 female) ranging in age from 35-78 years who were treated between June 2008 and January 2011. In these patients, previous attempts at recanalization using mechanical catheter/wire techniques had failed. The patients presented with a swollen arm and/or face secondary to benign central venous occlusions (7 subclavian veins, 19 brachiocephalic veins, and 5 superior vena cava veins) related to tunneled catheters. Simultaneous upper extremity (brachial approach) and central venograms (femoral approach) defined the central occlusion site.

The investigators used the PowerWireTM RF (Baylis Medical, Canada) wire, which was advanced within a 5-Fr KMP catheter. With this approach, a pre-stent 4 mm balloon angioplasty was followed by 10-12 mm stent placement. If the RF wire puncture was inadequate, the clinician pursued a new location. Clinical and venogram follow-ups occurred at 30 days post-treatment and again at 3, 6, and 12 months.

The RF wire technique successfully treated 29 patients. The procedure was aborted in two patients. In one case, the problem was due to hemothorax, which was successfully treated with a chest tube without clinical repercussions. All of the successfully treated patients had resolution of symptoms after a mean follow-up of seven months. Two of the 29 patients experienced stent occlusion within 30 days; the remaining stents were patent at nine months.  The patients were asymptomatic in all 27 cases.

“We are now getting nephrologists referring patients from other parts of the country,” Dr. Guimaraes told Renal & Urology News. “The complications have been very rare.”

The real key to the success with this technique is very close follow-up, Dr. Guimaraes said. “This is like when you buy a car,” he said. “We know there will be need for maintenance but we don't know if it will be in three months or in three years.”

Thus, he and his colleagues explain to patients that they need to return for a venogram as soon as they experience symptoms, he said.

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