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RF-Guidewire Opens Refractory Venous Occlusions
The guidewire burns through vascular occlusions, aiding recanalization in patients with ESRD.
BY MITCHEL L. ZOLER
HOLLYWOOD, FLA. -- A radiofrequency guidewire that functions by burning through vascular occlusions was found to be effective in helping to open central venous occlusions in a small study of 21 patients on dialysis who had previously failed standard recanalization methods.
"The Baylis PowerWire radiofrequency guidewire is an advancement for successfully traversing central venous occlusions," according to Dr. James F. McGuckin who spoke at ISET 2009, an international symposium on endovascular therapy.
The device aided recanalization in 21 patients in a series of 23 consecutive patients with end-stage renal disease who had technical failures when conventional methods were first tried, said Dr. McGuckin, who is an interventional radiologist and the medical director of the Philadelphia Vascular Institute.
Standard methods for opening a central venous occlusion in patients on kidney dialysis fail about 25% of the time when ipsilateral, upper-extremity hemodialysis access is used, and about 12% of the time using combined femoral and ipsilateral access when an attempt to traverse the occlusion is tried from both directions.
The radiofrequency guidewire is 0.035 inches in diameter and functions like a conventional guidewire except that it also can deliver bursts of radiofrequency energy to vaporize a channel through occlusions.
Ipsilateral access was through the dialysis fistula or graft and through the right common femoral vein in all 23 patients. The occlusions treated ranged from 1 cm to 8 cm in length, and three cases involved a chronically occluded, indwelling, self-expandable stent. Six of the patients also had an ipsilateral pacemaker in place.
PowerWire treatment was followed by balloon angioplasty, placement of a large, self-expanding stent, and then repeated, high-pressure and prolonged balloon expansion.
The procedure was complete once blood flow was continuous and the diameter of the previously occluded segment reached at least 10 mm, Dr. McGuckin said.
In one patient who was not successfully recanalized, the occlusion site was 90 degrees from the ipsilateral subclavian vein and could not be safely traversed with the guidewire.
The second failure involved an indwelling, occluded stent with multiple fractures. The metal shards of the broken stent prevented safe operation of the PowerWire.
Dr. McGuckin said that he has no financial relationship with Baylis Medical Company Inc., the company that markets the PowerWire.
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