• Emil I Cohen, Christopher Beck, Jesse Garcia, Ryan Muller, Hyun J Bang, Keith M Horton, and Farris Hakki.
• MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. Emil.I.Cohen@medstar.net.
• Cardiovasc Intervent Radiol. 2018 Jan 1; 41 (1): 73-79.

PurposeTo evaluate success and safety of needle (sharp) recanalization as a method to re-establish access in patients with chronic central venous occlusions.Materials And MethodsThirty-nine consecutive patients who underwent this procedure were retrospectively reviewed to establish success rate and associated complications. In all cases, a 21- or 22-gauge needle was used to restore connection between two chronically occluded segments after conventional wire and catheter techniques had failed. The needle was guided toward a target placed through a separate access by fluoroscopic guidance. When successful, the procedure was completed by placing a catheter, ballooning the segment, and/or stenting.ResultsThe procedure was successful in 37 of the 39 patients (95%). The vast majority of the treated lesions were in the SVC and/or right innominate vein. Occlusions ranged in length between 10 and 110 mm, and the average length of occluded venous segment was 40 mm in the treated group. There were four minor (SIR classification B) complications involving pain management after the procedure. There were two major (SIR classification D) complications both of which involved hemorrhage into the pericardium treated with covered stents (5.1%).ConclusionsSharp recanalization is a viable procedure for patients who have exhausted standard wire and catheter techniques. The operator performing this procedure should be familiar with potential complications so that they can be addressed urgently if needed.

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