Abstract 15245: Reconstruction of Completely Occluded Major Intrathoracic Vessels and Pathways - Results of Attempted Transcatheter Recanalization
Introduction: Occlusions of major intrathoracic vessels can be a cause of significant hemodynamic compromise for patients. Traditionally, surgical therapy for occlusion of vessels has been felt to be the mainstay of treatment and these lesions are often not considered amenable to transcatheter treatment.
Hypothesis: Transcatheter recanalization of occluded major intrathoracic vessels can be achieved in the majority of patients initially, although reintervention rates are high.
Methods: The records of patients with occluded major intrathoracic vessels who underwent a cardiac catheterization between 4/1997 and 2/2011 were reviewed. Patients with occluded systemic to pulmonary artery shunts, pulmonary veins, occlusions of other central veins and arteries (i.e. femoral veins and arteries) and vessels with in-stent occlusions were excluded.
Results: We identified 34 patients who underwent attempted recanalization and excluded 15 patients with pulmonary vein occlusion and 1 with acquired aortic atresia. There were 9 occluded pulmonary arteries and 9 occluded systemic veins. Recanalization was achieved in 17/18 (94%) patients. The occlusions were crossed with either stiff/stiff ends of guidewires, hydrophilic guidewires or transeptal needles. Primary angioplasty was performed in 5 patients with primary stenting in 12. Procedural adverse events occurred in 3 patients; peripheral vascular complication in 1 patient, vessel dissection in 1 patient and pulmonary hemorrhage in 1 patient. There was 1 death within 24 hours (unrelated to the procedure- due to pre-existing neurological lesions). Freedom from reintevention for the entire cohort was 60.58 % at 6 months, 34.62 % at 1 year and 34.62 % at 5 years. Freedom from an unplanned reintervention was 66.67 % at 6 months. There were 2 late deaths, unrelated to the procedure. At a median follow-up time of 34.7 months (6 months-11.6 years), 16/17 (94%) vessels have remained patent for 6 months or longer (1 patient with insufficient follow up).
Conclusions: Acute and chronic success at recanalizing occluded major intrathoracic vessels can be achieved via percutaneous techniques. Careful follow-up is needed, as reintervention is often necessary to maintain long-term vesssel patency without stenosis.
- © 2011 by American Heart Association, Inc.