Recanalization of chronic superior vena cava occlusion using a transseptal needle in a dialysis patient.
Luís Loureiro, Paulo Almeida, Davide Freitas et al.
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Case in brief
A dialysis patient with chronic superior vena cava occlusion presented with facial and upper-limb edema and prominent thoracic collateral veins. Extensive collateralization and exhausted access options complicated treatment, and prior attempts at endovascular re-entry had failed. Under biplanar fluoroscopy, a manually straightened transseptal needle was advanced from the femoral route to cross the occlusion. A guidewire was passed and snared through the left axillary loop graft, followed by deployment of a balloon-expandable stent-graft. Symptoms resolved by the following morning; no complications occurred, and patency remained stable at 9 months.
What made this case unusual
A manually straightened transseptal needle enabled sharp recanalization after re-entry devices and stiff guidewire techniques had failed.
Diagnostic / clinical pearl
In expert centers, a transseptal needle may provide an available sharp-recanalization option for chronic SVC occlusion when other endovascular strategies fail.