Outback LTD Re-Entry Device for Endovascular Recanalization of Central Venous Occlusions Associated with Failing Hemodialysis Access

Objectives: To report our experience with the Outback LTD re-entry device for endovascular recanalization of central venous occlusions associated with dysfunctional arteriovenous fistulas. Methods: Between January 2013 and January 2019, 11 patients (4 males and 7 females, mean age: 61.8 years) with dysfunctional fistulas secondary to central venous occlusion underwent endovascular treatment using the Outback LTD re-entry device. Reasons for referral were increased venous pressure during hemodialysis (N = 5), arm swelling (N = 5), and graft thrombosis (N = 1). The mean age of the fistulas was 58.1 months, during which time nine patients had prior history of at least one salvage endovascular procedure. In all patients, the Outback LTD re-entry device was used as a bail-out measure after failed attempts to cross the occluded central vein using conventional wiring techniques. A retrospective review was performed to assess the clinical outcome of these patients. Results: The site of occlusion was at the junction of the subclavian and innominate veins (N = 9), in the right innominate vein (N = 1), or in the subclavian vein (N = 1). The re-entry device was introduced via the outflow vein of the arm (N = 6), femoral vein (N = 4), or internal jugular vein (N = 1). Technical success was achieved in ten patients (90.9%), seven of whom required provisional placement of bare metallic stents. All ten patients underwent successful hemodialysis immediately after the procedure. Five patients with arm swelling were relieved of their symptoms. Excluding four patients who were lost for follow-up, the mean intervention-free period in the remaining six patients was 6.8 months, while the mean functional period of the fistula circuit after assisted procedures was 33.3 months. No complication related to the procedure was reported during this period. Conclusion: The Outback re-entry device can be safely and effectively used as a bail-out measure in patients who fail conventional wiring techniques during the endovascular treatment of central venous occlusions.

Publication History

Article published online:
26 April 2021