Abstract No. 507 Sharp Recanalization of Central Venous Occlusion of the Thorax in Hemodialysis Patients: A Meta-Analysis of 320 Cases

To evaluate the safety and clinical outcomes of different techniques for sharp recanalization of chronically occluded central veins of the thorax in vascular access. A systematic search of MEDLINE, PUBMED, and CINAHL Complete was conducted up to 20 January 2022. Two authors independently reviewed and selected relevant studies and extracted the data. Fourteen studies were identified as suitable for inclusion in the review: Technical success, adverse events and reported patency rates were evaluated. Proportions were pooled with a random effects model (95%CI) at trial level to account for anatomical and technical heterogeneity. 14 cohort studies including 320 cases presenting with central venous occlusion symptoms were compiled involving the superior vena cava (n=108), the brachiocephalic (n=159), the subclavian (n=92) and other central veins (n=11). Mean lesion length ranged from 1.0 to 8.2 cm. Sharp recanalization techniques included radiofrequency wires (n=55), transseptal needles (n=82), Chiba needles (n=95), stiff wire ends (n=54), or other (n=43). Overall, stents were placed in 70.3% of the cases (225/320). Technical success of sharp recanalization was 94.4% (90.2-96.9%). Risk of adverse events was 9.3% (6.2-13.8%; 30 events) of which serious ones was 4.2% (2.1-8.0%; 14 events). Reported patency was 79.1% (66.5-87.8%) after a median time of 12 months. Statistical heterogeneity was low to moderate. Various sharp recanalization techniques may be applied for chronic central venous occlusions with acceptable patency outcomes. Caution is warranted because of the increased risk of adverse events.