Application of sharp recanalization assisted by puncture instruments for superior vena cava occlusion in catheterization of hemodialysis patients_West China Medical Journal

Authors：

CHEN Qinghua ^1,2 , MOUSTAPHA HAROUN HAGGAR ² , LIU Li ² ,  CUI Tianlei ²

1. Hemodialysis Center, Dayi County People’s Hospital of Sichuan Province, Chengdu, Sichuan 611300, P. R. China;
2. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CUI Tianlei, Email: tianleicui@163.com

Keywords：

Puncture instrument; superior vena cava occlusion; hemodialysis; vascular access; sharp recanalization

DOI：

10.7507/1002-0179.202605063

Video：

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Objective To preliminarily evaluate the feasibility and safety of percutaneous sharp recanalization of the superior vena cava (SVC) with puncture instruments assistance followed by catheter placement in hemodialysis patients with exhausted central venous access resources. Methods A retrospective analysis was conducted on clinical data of hemodialysis patients who underwent RUPS-100-assisted sharp recanalization at West China Hospital, Sichuan University between March 2019 and August 2024. All patients were diagnosed with SVC occlusion via digital subtraction angiography or computed tomographic angiography and conventional guidewires and catheters failed to traverse the occlusive lesions as judged by operators. The technical success rate, perioperative complications, post-procedure blood flow volume, and catheter patency rate were recorded. Results A total of 17 patients were enrolled, among whom sharp recanalization was successfully performed in 14 cases, corresponding to a technical success rate of 82.4%. The mean length of recanalized occlusive segment was (2.2±0.5) cm, and the mean procedural time was (73.4±9.5) minutes. One patient developed intraoperative hemopericardium (Society of Interventional Radiology adverse event grade C), which improved under close monitoring and conservative management without progression to cardiac tamponade. The post-procedure blood flow was maintained above 240 mL/min in all successfully recanalized patients. The primary patency rates at 6 months and 12 months were 92.9% and 66.7%, respectively. Conclusions RUPS-100-assisted sharp recanalization is an effective and acceptably safe salvage procedure for the treatment of SVC occlusion in hemodialysis patients, offering a novel therapeutic option for patients with refractory vascular access dysfunction. Given the limitations of its retrospective, single-center and small-sample design, further large-scale studies are required to validate these findings.

Citation： CHEN Qinghua, MOUSTAPHA HAROUN HAGGAR, LIU Li, CUI Tianlei. Application of sharp recanalization assisted by puncture instruments for superior vena cava occlusion in catheterization of hemodialysis patients. West China Medical Journal, 2026, 41(7): 1096-1100. doi: 10.7507/1002-0179.202605063 Copy

1.	Chen B, Lin R, Dai H, et al. Sharp recanalization for treatment of central venous occlusive disease in hemodialysis patients[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(2): 306-312.
2.	Sohail MA, Vachharajani TJ, Anvari E. Central venous catheters for hemodialysis-the myth and the evidence[J]. Kidney Int Rep, 2021, 6(12): 2958-2968.
3.	Rizk T, Gayed A, Stringfellow S, et al. Review of sharp recanalization techniques in central venous occlusions[J]. Cardiovasc Intervent Radiol, 2024, 47(12): 1626-1641.
4.	Wu XW, Zhao XY, Li X, et al. Effectiveness of sharp recanalization of superior vena cava-right atrium junction occlusion[J]. World J Clin Cases, 2021, 9(16): 3848-3857.
5.	Khalilzadeh O, Baerlocher MO, Shyn PB, et al. Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee[J]. J Vasc Interv Radiol, 2017, 28(10): 1432-1437. e3.
6.	Athreya S, Scott P, Annamalai G, et al. Sharp recanalization of central venous occlusions: a useful technique for haemodialysis line insertion[J]. Br J Radiol, 2009, 82(974): 105-108.
7.	Arabi M, Ahmed I, Mat’hami A, et al. Sharp central venous recanalization in hemodialysis patients: a single-institution experience[J]. Cardiovasc Intervent Radiol, 2016, 39(6): 927-934.
8.	Cohen EI, Beck C, Garcia J, et al. Success rate and complications of sharp recanalization for treatment of central venous occlusions[J]. Cardiovasc Intervent Radiol, 2018, 41(1): 73-79.
9.	Goo DE, Kim YJ, Choi DL, et al. Use of a rosch-uchida needle for recanalization of refractory dialysis-related central vein occlusion[J]. AJR Am J Roentgenol, 2010, 194(5): 1352-1356.
10.	McDevitt JL, Srinivasa RN, Gemmete JJ, et al. Approach, technical success, complications, and stent patency of sharp recanalization for the treatment of chronic venous occlusive disease: experience in 123 patients[J]. Cardiovasc Intervent Radiol, 2019, 42(2): 205-212.
11.	de Graaf R, van Laanen J, Sailer A, et al. Long segment recanalization and dedicated central venous stenting in an ultimate attempt to restore vascular access central vein outflow[J]. J Vasc Access, 2014, 15(Suppl 7): S109-S113.
12.	Sadarmin PP, Uberoi R, Tomlinson DR, et al. ICD lead implantation following sharp cannulation of a blocked superior vena cava[J]. Pacing Clin Electrophysiol, 2011, 34(9): e82-e84.
13.	Guimaraes M, Schonholz C, Hannegan C, et al. Radiofrequency wire for the recanalization of central vein occlusions that have failed conventional endovascular techniques[J]. J Vasc Interv Radiol, 2012, 23(8): 1016-1021.
14.	Lang EV, Reyes J, Faintuch S, et al. Central venous recanalization in patients with short gut syndrome: restoration of candidacy for intestinal and multivisceral transplantation[J]. J Vasc Interv Radiol, 2005, 16(9): 1203-1213.
15.	Nifong TP, McDevitt TJ. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters[J]. Chest, 2011, 140(1): 48-53.
16.	Razavi MK, Peden EK, Sorial E, et al. Efficacy and safety associated with the use of the Surfacer^? Inside-Out^? access catheter system: results from a prospective, multicenter Food and Drug Administration-approved investigational device exemption study[J]. J Vasc Access, 2021, 22(1): 141-146.
17.	Davis RM, David E, Pugash RA, et al. Radiofrequency guide wire recanalization of venous occlusions in patients with malignant superior vena cava syndrome[J]. Cardiovasc Intervent Radiol, 2012, 35(3): 676-679.
18.	Keller EJ, Gupta SA, Bondarev S, et al. Single-center retrospective review of radiofrequency wire recanalization of refractory central venous occlusions[J]. J Vasc Interv Radiol, 2018, 29(11): 1571-1577.
19.	Dai R, Kim CY. Blunt transmediastinal dissection with radiofrequency wire reentry for extravascular bypass of thoracic central venous occlusions refractory to recanalization[J]. J Vasc Interv Radiol, 2021, 32(4): 558-561.

1. Chen B, Lin R, Dai H, et al. Sharp recanalization for treatment of central venous occlusive disease in hemodialysis patients[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(2): 306-312.
2. Sohail MA, Vachharajani TJ, Anvari E. Central venous catheters for hemodialysis-the myth and the evidence[J]. Kidney Int Rep, 2021, 6(12): 2958-2968.
3. Rizk T, Gayed A, Stringfellow S, et al. Review of sharp recanalization techniques in central venous occlusions[J]. Cardiovasc Intervent Radiol, 2024, 47(12): 1626-1641.
4. Wu XW, Zhao XY, Li X, et al. Effectiveness of sharp recanalization of superior vena cava-right atrium junction occlusion[J]. World J Clin Cases, 2021, 9(16): 3848-3857.
5. Khalilzadeh O, Baerlocher MO, Shyn PB, et al. Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee[J]. J Vasc Interv Radiol, 2017, 28(10): 1432-1437. e3.
6. Athreya S, Scott P, Annamalai G, et al. Sharp recanalization of central venous occlusions: a useful technique for haemodialysis line insertion[J]. Br J Radiol, 2009, 82(974): 105-108.
7. Arabi M, Ahmed I, Mat’hami A, et al. Sharp central venous recanalization in hemodialysis patients: a single-institution experience[J]. Cardiovasc Intervent Radiol, 2016, 39(6): 927-934.
8. Cohen EI, Beck C, Garcia J, et al. Success rate and complications of sharp recanalization for treatment of central venous occlusions[J]. Cardiovasc Intervent Radiol, 2018, 41(1): 73-79.
9. Goo DE, Kim YJ, Choi DL, et al. Use of a rosch-uchida needle for recanalization of refractory dialysis-related central vein occlusion[J]. AJR Am J Roentgenol, 2010, 194(5): 1352-1356.
10. McDevitt JL, Srinivasa RN, Gemmete JJ, et al. Approach, technical success, complications, and stent patency of sharp recanalization for the treatment of chronic venous occlusive disease: experience in 123 patients[J]. Cardiovasc Intervent Radiol, 2019, 42(2): 205-212.
11. de Graaf R, van Laanen J, Sailer A, et al. Long segment recanalization and dedicated central venous stenting in an ultimate attempt to restore vascular access central vein outflow[J]. J Vasc Access, 2014, 15(Suppl 7): S109-S113.
12. Sadarmin PP, Uberoi R, Tomlinson DR, et al. ICD lead implantation following sharp cannulation of a blocked superior vena cava[J]. Pacing Clin Electrophysiol, 2011, 34(9): e82-e84.
13. Guimaraes M, Schonholz C, Hannegan C, et al. Radiofrequency wire for the recanalization of central vein occlusions that have failed conventional endovascular techniques[J]. J Vasc Interv Radiol, 2012, 23(8): 1016-1021.
14. Lang EV, Reyes J, Faintuch S, et al. Central venous recanalization in patients with short gut syndrome: restoration of candidacy for intestinal and multivisceral transplantation[J]. J Vasc Interv Radiol, 2005, 16(9): 1203-1213.
15. Nifong TP, McDevitt TJ. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters[J]. Chest, 2011, 140(1): 48-53.
16. Razavi MK, Peden EK, Sorial E, et al. Efficacy and safety associated with the use of the Surfacer^? Inside-Out^? access catheter system: results from a prospective, multicenter Food and Drug Administration-approved investigational device exemption study[J]. J Vasc Access, 2021, 22(1): 141-146.
17. Davis RM, David E, Pugash RA, et al. Radiofrequency guide wire recanalization of venous occlusions in patients with malignant superior vena cava syndrome[J]. Cardiovasc Intervent Radiol, 2012, 35(3): 676-679.
18. Keller EJ, Gupta SA, Bondarev S, et al. Single-center retrospective review of radiofrequency wire recanalization of refractory central venous occlusions[J]. J Vasc Interv Radiol, 2018, 29(11): 1571-1577.
19. Dai R, Kim CY. Blunt transmediastinal dissection with radiofrequency wire reentry for extravascular bypass of thoracic central venous occlusions refractory to recanalization[J]. J Vasc Interv Radiol, 2021, 32(4): 558-561.

West China Medical Journal

Application of sharp recanalization assisted by puncture instruments for superior vena cava occlusion in catheterization of hemodialysis patients

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