Central venous occlusions (CVOs) are a common complication that may be observed subsequent to the placement of central venous catheters. Previous studies have reported the incidence of venous thrombosis, the formation of which may result in CVOs, to be between approximately 3% and 38% after the placement of peripherally inserted central venous catheters and venous ports.1 The most common etiology of symptomatic lesions results from the long-term catheterization of patients for hemodialysis to treat endstage renal disease (ESRD). The presence of an ipsilateral vascular access greatly increases the blood flow in an upper extremity such that 70% of patients who have an ipsilateral hemodialysis access will become symptomatic with a CVO as compared to the 10% of nondialysis patients that become symptomatic. Ipsilateral hemodialysis access with a pacemaker are compounding risk variables. Symptoms that may develop due to a CVO include an acutely swollen arm, neck pain, facial swelling, and chest wall varicosities. Percutaneous treatment is a more common choice than thoracic surgery for alleviating these symptoms due to the high morbidity and mortality rates in ESRD patients with high upper extremity blood flow.
Failed central venous occlusion (CVO) recanalization leads to several unpalatable treatment options: surgical banding or take down of the ipsilateral dialysis access, surgical reconstruction with possible rip resection/thoracotomy, or the need for the patient to tolerate underlying symptoms secondary to the obstruction and possibly poor quality of hemodialysis related to recirculation.
A new device provides relief to patients with swollen arms and legs as a result of their medical conditions, such as those who are on dialysis for kidney failure, or who have pacemakers. These patients have permanent devices in their veins, which can causes scarring and reduce blood flow, leading to swollen extremities. Doctors use a variety of techniques to open up the completely blocked veins (called a central venous occlusion, or CVO), but efforts fail 10 to 12 percent of the time, and those patients are miserable because their extremities are very swollen. The new device, the Baylis PowerWire™ Radiofrequency (RF) Guidewire, is advanced to the site of the scarring using minimally invasive techniques. RF energy is used to burn through the blockage.
