Chronic total occlusion without collateral blood flow does not exclude myocardial viability and subsequent recovery after revascularization

Introduction: Conventional guidewire techniques are not always sufficient to restore arteriovenous graft patency in patients with challenging vascular scenarios. We discuss a novel approach to the treatment of chronic total occlusion of the venous outflow tract to enable successful arteriovenous graft thrombectomy. Case presentation: A 28-year-old female with end-stage renal disease on chronic hemodialysis and recurrent arteriovenous graft thromboses presented with a clotted thigh graft. An existing ipsilateral common femoral vein stent was found to be chronically occluded, causing persistent venous outflow obstruction and rendering an initial attempt at thrombectomy unsuccessful due to wire buckling and the inability to navigate through the stent chronic total occlusion. Results: After establishing femoral vein access, a vibrational recanalization device was used to cross the occluded stent. The device was then removed, permitting routine angioplasty. Post-angioplasty angiogram revealed persistent intra-stent stenosis, so a covered stent was deployed with good angiographic results. Routine pharmaco-mechanical thrombectomy of the arteriovenous graft was then performed. Two additional stents were placed due to stenotic recoil in the venous limb of the graft. Angioplasty was also performed at the arteriovenous graft arterial anastomosis. Repeat imaging demonstrated marked improvement in the graft blood flow. Discussion: Total occlusion of the venous outflow tract prevents adequate blood flow through an arteriovenous graft and undermines successful thrombectomy. We describe the use of the Crosser vibrational recanalization device for the safe and effective treatment of a chronic total occlusion of the venous outflow tract, thus extending the life of the patient’s vascular access for hemodialysis.

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Preserved myocardial viability in patients with chronic total occlusion of a single coronary artery

Journal of Nuclear Cardiology ◽

10.1007/s12350-020-02134-z ◽

2020 ◽

Cited By ~ 1

Author(s):

Xiao-Xin Sun ◽

Shuheng Li ◽

Wei Fang ◽

Yue-Qin Tian ◽

Rui Shen ◽

...

Keyword(s):

Coronary Artery ◽

Myocardial Viability ◽

Chronic Total Occlusion ◽

Single Coronary Artery ◽

Total Occlusion

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Effects of endurance exercise on coronary collateral blood flow in miniature swine

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1978.234.5.h614 ◽

1978 ◽

Vol 234 (5) ◽

pp. H614-H619 ◽

Cited By ~ 9

Author(s):

M. Sanders ◽

F. C. White ◽

T. M. Peterson ◽

C. M. Bloor

Keyword(s):

Blood Flow ◽

Endurance Exercise ◽

Aortic Pressure ◽

Collateral Blood Flow ◽

Miniature Swine ◽

Circumflex Artery ◽

Total Occlusion ◽

Left Circumflex Artery ◽

Coronary Collateral ◽

Coronary Collateral Blood Flow

Coronary collateral blood flow was measured in 7 miniature pigs, exercise trained (ET) for 10 mo by running about 35 km/wk, and in 10 sedentary control pigs (SC). In acute, open-chest preparations, radiolabeled (85SR, 141CE, or 51Cr) microspheres, 15 +/- 5 micron in diameter, were injected into the left atrium during each of three conditions: control (C), total occlusion of the left circumflex artery (TO), and TO plus mechanically elevated aortic pressure (TOP). Blood flow to the circumflex bed during control condition in ET and SC was 0.36 +/- 0.07 (SE) and 0.43 +/- 0.10 ml.g-1.min-1, respectively. During TO, circumflex flow in ET and SC fell to 0.05 +/- 0.01 and 0.06 +/- 0.01 ml.g-1.min-1, respectively. In the presence of TOP, left circumflex flow in ET and SC rose to 0.11 +/- 0.04 and 0.11 +/- 0.02 ml.g-1.min-1, respectively. Blood flow to the tissue bed of the left anterior descendens was the same in both groups of pigs under all conditions. Thus, 10 mo of endurance exercise training seems to have no effect on the development of coronary collaterals in the left ventricles of pig hearts.

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