Radiofrequency-Assisted Recanalization in a Patient with SVC Syndrome

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Presentation transcript:

Radiofrequency-Assisted Recanalization in a Patient with SVC Syndrome Mo Bader, R2 Tufts Medical Center • Department of Radiology • 800 Washington Street, MA 02111

Case: 58 F smoker PMHx: Presented to OSH 10/5/16 Hodgkin’s Lymphoma s/p BMT Recurrence Chemoradiation therapy Recent PET scans stable, per outside oncologist Chronic SVC occlusion Presented to OSH 10/5/16 6 days progressive dyspnea worsening cough

Case: 58 F smoker Presentation (continued): O2 sat: 56% on RA Labs: WBC 41,000 Lactate: 12 Anion gap: 27 Intubated, transferred to Tufts MICU

Brief Hospital Course Day 1 VA ECMO Broad-spectrum ABX Days 2-10: ARF requiring CRRT ECMO decannulation on day 5 Day 16: worsening sepsis CECT IR consulted: HD catheter TL catheter

Brief Hospital Course Days 17-25: Q: Long-term HD access? No longer on ECMO Pressors weaned ABX discontinued CRRT  HD Q: Long-term HD access?

Options Translumbar Transhepatic Femoral Recanalization

(CECT)

Initial Venogram:

L. Approach

R. Approach

Marking Catheters

Stenting

Completion

RF Wire Recanalization of Central Venous Occlusion MUSC (2008-2011): 42 patients with symptomatic CVO or SVC syndrome in whom conventional endovascular techniques failed Successfully crossed 43/43 lesions (up to 10 cm) 40/42 patency & asymptomatic at 6, 9 months\ One major complication: cardiac tamponade Journal of Vascular and Interventional Radiology , Volume 23 , Issue 8 , 1016 - 1021

RF Wire Recanalization of Central Venous Occlusion Tufts (2007-12): Technical success in 9/13 vessels (69%); 9/12 patients Length of occlusion smaller in successful (30 mm) vs unsuccessful cases (90 mm); (p 0.03) One major complication (tracheal perforation)

RF Wire Recanalization of Central Venous Occlusion Tufts (2013-present): Technical success in 10/10 vessels (9/9 patients) No major complications Take-home: In carefully selected patients, technical success may approach 100%

Thank You!!