Novel therapy for recanalization of chronic iliocaval venous occlusion using radiofrequency

Abstract

Objective: Chronic venous disease of the lower extremities is one of the most common diseases in the United States. The sequelae of this disease process are the source of a significant amount of morbidity, and its prevalence is expected to increase in the coming decades. Interventional therapy is warranted for relief of patients with CEAP C3-C6 disease. With advances in endovascular therapy, chronic iliocaval venous occlusion (CICVO) pathology can be corrected through minimally invasive approaches with limited morbidity and mortality. However, failure to recanalize the venous system leads to high failure rates. The purpose of this study was to assess the procedural success for recanalization of CICVO in the community setting using the novel technique of the Baylis radiofrequency (RF) wire in patients who had failed previous endovascular intervention.

Methods: A retrospective review of patients who underwent RF recanalization for CICVO at our institution from 2019 to 2020 was conducted. All patients had failed previous endovascular attempts at recanalization. The primary outcome was recanalization (defined as restoration of >70% of luminal patency as determined on multiplanar venography [MPV] and intravascular ultrasound [IVUS]) confirmed on both IVUS and MPV. Secondary outcomes included adjunctive interventions and complications (hematoma, pulmonary embolism, new onset renal insufficiency).

Results: A total of 10 patients, 50% male with a mean (standard deviation) age of 58.4 (10.4), were evaluated in the study. Successful recanalization was achieved in 60% of cases, with a resolution of >70% of luminal obstruction observed using MPV and IVUS. Adjunctive interventions were performed in 70% of cases. There were no clinically significant complications or blood transfusion requirements.

Conclusions: New techniques and technologies continue to be developed for advanced endovascular management of CICVO, especially with the expanding market for Food and Drug Administration approved venous stents. The Baylis RF wire can assist in recanalization and treatment of patients who had failed previous endovascular therapy.

Keywords: Chronic iliocaval venous occlusion; Intravascular ultrasound; Radiofrequency; Recanalization; Venography.