In the paper on sharp needle recanalization,, the patency falls off sharply by 9 months although the procedures can be repeated. Authors gave me no idea as to the average length of time needed to perform the procedure (min to max helpful as it would depend somewhat on anatomy. How many times would you do the procedure and are secondary patients due to same lesion or a different lesion elsewhere?
The UK guidelines seem reasonable, but I am not an interventionalist so can't really comment

Anatole

The sharp needle technique looks interesting - however it looks like they treated the crossed lesions with PTA or bare metal stents only.
We know from the literature that bare metal outcomes are not much better than balloon angioplasty. Patency rates likely would be significantly improved with stent-graft placement - which would provide a barrier to ingrowth of neointimal hyperplasia.
We see similar patency rates when we can cross total occlusions by conventional methods – these are generally aggressive lesions that have a high rate of recurrence. Given the time and work it sometimes takes to cross these aggressive lesions, I usually place stent-grafts the first time I see these total occlusions. However, outcomes with drug-coated balloons vs stent-grafts would be interesting to see here.
This looks like it could take some time to do this procedure, depending on the anatomy. However, as interventionalists get better at endo AVF creation (where the Ellipsys procedure uses needle/Ultrasound guidance to access smaller caliber veins), this may not be as difficult to approach. Its an interesting approach, that is worth a consideration for accessible total occlusions.

Danny Patel