Transseptal needle approach can recanalize superior vena cava occlusion

A transseptal needle can be used to recanalize the complete long-segment occlusion of the superior vena cava (SVC) without needing to invest further vascular resources, a recent study has found.

The researchers conducted a retrospective medical record review of nine haemodialysis patients who had undergone sharp recanalization using a transseptal needle after central venous occlusion. The procedure was successful in seven patients. The primary patency rates at 6 and 12 months were 100 percent and 85.7 percent, respectively.

The two procedure failures were due to the closer distance from the lesion to the atrioventricular junction; one patient developed pericardial tamponade during the operation. No deaths associated with the procedure occurred.

The transseptal needle procedure used a loop advanced to the distal end of the occlusion via the antegrade arm vein or antegrade jugular vein approaches. The transseptal needle was inserted through the right femoral vein and was advanced using the loop as its target. Venography information was used to aid the meeting of the needle and the loop, followed by catheter placement and/or angioplasty to re-establish vascular access.

“It is difficult to reconstruct vascular access and conserve vascular resources in patients with refractory central vein occlusion, especially during recanalization of complete long-segment occlusions,” the researchers said.

Conventional techniques often make use of a guidewire but have high rates of complications, often leading to procedure failure.

The present study describes a safe and effective alternative procedure for recanalization in these patients. Future studies are needed to confirm these findings.