When hemodialysis-dependent patients exhaust all conventional venous access options, how do IRs navigate complex central occlusions to provide a lifeline? In this episode of the BackTable Podcast, Dr. Gian Paolo Zamboni of Clínica Alemana in Santiago, Chile joins guest host Dr. Neil Jain to discuss workup protocols and advanced technical algorithms for complex central venous recanalization cases.

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Timestamps

00:00 - Introduction
03:06 - IR Practice and Referrals in Santiago
07:19 - Pre-Procedure Workup
15:06 - Standard Recanalization Techniques
20:14 - Dual-Access Sharp Recanalization
24:43 - Needle Maneuvers and Alternatives
29:32 - Predilation, IVUS, and Stent Sizing
37:42 - Transhepatic Technique and Indications
45:45 - Tract Closure, Anticoagulation, and Follow-up
50:03 - Advice and Closing Remarks

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More about this episode

The physicians review the critical role of pre-procedural planning, emphasizing the necessity of thorough workup with CT venography to accurately assess remaining vascular capital. Dr. Zamboni shares how his group addresses severe central venous occlusions, outlining a structured, stepwise approach that begins with standard maneuvers and progresses to sharp recanalization techniques before opting for dual-access approaches. He outlines critical safety measures, highlighting the importance of performing intraprocedural cardiac ultrasound, pre-dilating with caution, and keeping covered stents on the shelf to prevent fatal cardiac tamponade. For patients who lack viable conventional iliofemoral and IVC access, Dr. Zamboni shares an advanced jugular-to-transhepatic strategy, walking through the steps and nuances of creating a reliable working route, optimizing inflow, and managing post-procedure anticoagulation. Finally, Dr. Zamboni offers invaluable advice for IRs on mastering foundational techniques before tackling advanced cases and building strong, collaborative relationships with referring providers.

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

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