Sharp recanalization for chronic central venous occlusions

When catheter and guidewire techniques do not permit connection of 2 patent lumina, sharp recanalization becomes an option. Sharp recanalization of chronically occluded central veins is indicated in patients with symptomatic superior vena cava (SVC) syndrome, massive upper extremity swelling, dysfunctional dialysis fistulae, and need for large-bore central venous access. The principle of the technique includes placement of a lower extremity and upper extremity access to exactly delineate the extent of the occlusion. Under triangulation fluoroscopy, the occlusion is transgressed with a sharp recanalization set from the downstream territory toward the pressurized upstream territory. After establishment of a through-and-through access, balloon dilatation and stenting is performed. Our current series includes 12 patients. Based on this small number, the success rate for sharp recanalization does not seem to differ from that of standard catheter guidewire recanalization. Long-term patency is problematic, particularly in patients with benign lesions.