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.
