Radiofrequency Wire Recanalization of Chronically Occluded Venous Stents: A Retrospective, Single-Center Experience in 15 Patients.

INTRODUCTION: Chronically occluded venous stents may be difficult to salvage, necessitating multiple approaches and adjunctive techniques. Radiofrequency wires have been used to cross chronic obstructions in a variety of settings. Herein, radiofrequency wire recanalization (RFWR) of chronically occluded venous stents is presented. MATERIALS AND METHODS: Fifteen patients (8 males; 7 females) aged 23-74 years (median 42 years) underwent prior venous stenting in the setting of venous occlusions. Seven had an underlying coagulopathy, three had May-Thurner syndrome, three had provoked deep venous thrombosis, one had a dialysis fistula, and one had pacer leads in situ. All indwelling venous stents were chronically occluded and symptomatic. Out of 15 patients, 13 (87%) had iliocaval venous stents, while two (13%) had superior vena cava and/or upper extremity venous stents. After failing conventional and blunt recanalization techniques, RFWR was performed to traverse the chronic occlusions. Technical success and complications were recorded. RESULTS: Fifteen patients underwent 19 procedures. Twelve patients underwent one procedure, two patients had two procedures, and one patient had three procedures. RFWR alone was used in 12/19 (63%) procedures, while 7/19 (37%) required adjunctive sharp recanalization techniques. Technical success or crossing of the occlusion with flow restoration through the occluded segments was achieved in 17/19 (89%). One major and one minor complication occurred. CONCLUSION: Radiofrequency wire recanalization is an effective adjunct to revise chronically occluded venous stents, potentially increasing procedural success in challenging cases.

Ultrasound-Guided Fine-Needle Aspiration With Optional Core Needle Biopsy of Head and Neck Lymph Nodes and Masses: Comparison of Diagnostic Performance in Treated Squamous Cell Cancer Versus All Other Lesions.

OBJECTIVES: To evaluate the diagnostic performance of ultrasound (US)-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses, with attention to differences between biopsy of treated squamous cell carcinoma (SCC) and biopsy of other lesions. METHODS: Institutional Review Board approval was obtained, and the need for consent was waived for this retrospective study. All 861 US-guided biopsies of head and neck lymph nodes and masses performed between March 1, 2012, and May 16, 2016, were reviewed. RESULTS: Of the 861 biopsies, 53 targeted SCC with residual masses after treatment. The biopsy procedures yielded benign or malignant pathologic results in 71.7% (38 of 53) of treated SCC and 90.7% (733 of 808) of all other lesions (P < .001). A reference standard based on subsequent pathologic results or clinical and imaging follow-up was established in 68.4% of procedures. In cases with benign or malignant biopsy results and a subsequent reference standard, the sensitivity values for malignancy were 87.5% (95% confidence interval, 64.0%-96.5%) in treated SCC and 98.3% (95% confidence interval, 96.0%-99.3%) in all other cases (P = .047), and the specificity values were 63.6% (95% confidence interval, 35.4%-84.8%) in treated SCC and 99.5% (95% confidence interval, 97.3%-99.9%) in all other cases (P < .001). There were no major complications related to the biopsy procedures. CONCLUSIONS: Excluding treated SCC, US-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses has excellent diagnostic performance. Needle biopsy of head and neck SCC with a residual mass after therapy has a high rate of nondiagnostic samples, suboptimal sensitivity, and poor specificity.