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

ABSTRACT

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.