Balloon-Targeted Extra-Anatomic Sharp Recanalization Technique to

Re-establish Supraclavicular Vascular Access

5 patients with concurrent thoracic central venous and bilateral internal jugular vein occlusions who underwent sharp recanalization using the BEST technique. Technical success was achieved in all cases without major adverse events Four od the 5 patients underwent hemodialysis reliable outflow (HeRO) graft placement.

I think this is a better way to go compared to putting in another TCC. Still it is a desperate attempt to save an access site Would love to avoid them alltogether.



Goals Based a Systematic Review and Meta-Analysis of Clinical Outcomes for Bare-Metal

Stents and Percutaneous Transluminal Angioplasty for Hemodialysis-Related Central Venous Obstruction



Of 66 studies published between 2000 and 2021, only 17 met inclusion criteria . Studies were a mix of PTA with stent , PTA /stent, and only stent. Looked at Primary patency at 6 and 12 months. Initial success was equal.at about 95%. Based on the CI for each of the three interventions, PTA+ stent produced the highest highest patency rates than PTA only at the 6 month time points, 69.7% vs 50,9% (P 0.002) but not at 12 month time point, 47.9% compared to 36.7%.



Reporting of access loss and AEs was variable across the included studies, and

this resulted in a wide range of reported values. Apparently access loss rates were higher for stent placement (30% than for PTA alone, (14%) Procedural AE were lower ,with stent placement alone, 3.% vs PTA alone10.8%.some of this data is confusing since it is not clear how the group PTA/stent was defined. Bothe, either one?



They used the right model, random-effects because of the obvious difference in approach for the 3 types of interventions.



Overall this is a good start for the design of a prospective multicenter trial because ay least we have a size effect value to determine the number of subjects needed.



Abigail, we need to do pragmatic RTC (ie all patients at a site have the same of 2 procedures, i.e. cluster randomization) as this logistically is easier to do and cheaper. However, it takes the interventionalist judgement out of play. Since there is no definitive proof and this meta analysis is not definitive, a true RCT could be done but then its more complex in terms of data collection and is much more costly.

That is always the problem. Who leads and which is the main center.



Anatole