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

2. 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

3. 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

4. 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

5. 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?

6. Options
Translumbar
Transhepatic
Femoral
Recanalization

7. (CECT)

8. Initial Venogram:

9. L. Approach

10. R. Approach

11. Marking Catheters

12. Stenting

13. Completion

14. RF Wire Recanalization of Central Venous Occlusion
MUSC ( ):
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 ,

15. RF Wire Recanalization of Central Venous Occlusion
Tufts ( ):
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)

16. 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%

17. Thank You!!