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Radiofrequency wire technique and image fusion in the creation of an endovascular bypass to treat chronic central venous occlusion  Ricardo Yamada, MD,

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Presentation on theme: "Radiofrequency wire technique and image fusion in the creation of an endovascular bypass to treat chronic central venous occlusion  Ricardo Yamada, MD,"— Presentation transcript:

1 Radiofrequency wire technique and image fusion in the creation of an endovascular bypass to treat chronic central venous occlusion  Ricardo Yamada, MD, Beatriz Bassaco, MPH, Clark Wise, BS, Laura Barnes, MD, Nima Golchin, MD, Marcelo Guimaraes, MD, FSIR  Journal of Vascular Surgery Cases and Innovative Techniques  Volume 5, Issue 3, Pages (September 2019) DOI: /j.jvscit Copyright © 2019 The Authors Terms and Conditions

2 Fig 1 A, Preoperative abdominal image of 41-year-old African American woman with painful varicosities of the torso. Note multiple tortuous and enlarged varicose veins on the anterior chest and abdominal wall. B, Central venography performed through upper extremity accesses confirms central venous occlusion (CVO) involving right subclavian and bilateral brachiocephalic veins, with collaterals draining into the superior vena cava (SVC). C, Selective central venography through diagnostic catheters placed in the left upper extremity and femoral accesses better delineates the occluded left brachiocephalic segment. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, DOI: ( /j.jvscit ) Copyright © 2019 The Authors Terms and Conditions

3 Fig 2 A, Vascular anatomy (orange) extracted from prior chest computed tomography angiography and fused with real-time fluoroscopy through the integrated registration software. This software allows accurate superimposition of images using anatomic landmarks such as bones. B, Image demonstrating the 10-mm snare positioned within the superior vena cava (SVC) stump through the right femoral vein and the radiofrequency (RF) wire positioned within the left brachiocephalic vein. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, DOI: ( /j.jvscit ) Copyright © 2019 The Authors Terms and Conditions

4 Fig 3 A, Anteroposterior view during advancement of the radiofrequency (RF) wire toward the snare, showing appropriate alignment. B, Oblique view confirming RF wire and snare in the same plane. C, Anteroposterior view showing the RF wire across the occluded segment and “captured” by the snare. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, DOI: ( /j.jvscit ) Copyright © 2019 The Authors Terms and Conditions

5 Fig 4 A, Catheter-based digital subtraction aortogram with flushing catheter positioned in the ascending aorta. Note the radiofrequency (RF) wire overlapping the supra-aortic vessels on this anteroposterior view (arrows). B, Aortogram fused with intraprocedural cone beam computed tomography image with sagittal reconstruction demonstrating the RF wire (arrow) within the retrosternal space anterior to the left subclavian artery (arrowhead). C, Aortogram fused with intraprocedural cone beam computed tomography image on axial reconstruction demonstrating appropriate location of the RF wire (arrow) within the mediastinum. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, DOI: ( /j.jvscit ) Copyright © 2019 The Authors Terms and Conditions

6 Fig 5 A, Completion venogram. B, The 3-week follow-up venogram. C, The 14-month follow-up venogram. D, Follow-up clinical evaluation shows flattening of the varicosities at 6 months after the procedure (this was obtained with different equipment and in a different room compared with the preprocedure clinical picture to account for any difference in brightness). Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, DOI: ( /j.jvscit ) Copyright © 2019 The Authors Terms and Conditions

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