Efficacy and Safety of Sharp Recanalization with the Stiff End of a Microguidewire for Treatment of Refractory Central Venous Occlusions in Hemodialysis Patients

Background: Sharp recanalization is a viable procedure for some refractory central venous occlusions that cannot be recanalized with the conventional technique. The sharp recanalization procedures reported in previous studies are often rely on costly devices and with a certain proportion of complications. This study aimed to present an inexpensive and risk-controllable coaxial centrifugally sharp recanalization technique that was independent of any additional costly devices. Methods: This retrospective study enrolled 8 patients who had received sharp recanalization of central venous occlusions, between August 2017 and May 2021. The sharp recanalization technique was performed centrifugally with the stiff end of a microguidewire after the lesions failed to be passed through with the conventional technique. Clinical data of patients on their lesions, technical success rate, procedure-related complications, and patency rates were collected and analyzed to assess the efficacy and safety of the technique. Results: Technical success was achieved in all patients, with no complications were observed. All symptoms were ameliorated within 48h postsurgery. The median follow-up period was 22 months. All patients maintained patency or assisted patency at 12 month follow-up. Conclusions: Sharp recanalization performed centrifugally with the stiff end of the microguidewire could be a cost-effective and safe alternative procedure for the treatment of refractory central venous occlusion that cannot be recanalized with conventional technique.