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BackTable / VI / Podcast / Episode #290

SVC Sharp Recanalizations

with Dr. Abdulaziz Alharbi

In this episode, Dr. Aaron Fritts interviews interventional radiologist Dr. Abdulaziz Alharbi of the Ministry of National Guard Health Affairs in Saudi Arabia. They discuss Dr. Alharbi’s approach to planning and performing sharp recanalization of the superior vena cava (SVC) for dialysis, transplant, and cancer patients.

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SVC Sharp Recanalizations with Dr. Abdulaziz Alharbi on the BackTable VI Podcast)
Ep 290 SVC Sharp Recanalizations with Dr. Abdulaziz Alharbi
00:00 / 01:04

BackTable, LLC (Producer). (2023, February 10). Ep. 290 – SVC Sharp Recanalizations [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Abdulaziz Alharbi discusses SVC Sharp Recanalizations on the BackTable 290 Podcast

Dr. Abdulaziz Alharbi

Dr. Alharbi is a practicing Interventional Radiologist in Riyadh, Saudi Arabia

Dr. Aaron Fritts discusses SVC Sharp Recanalizations on the BackTable 290 Podcast

Dr. Aaron Fritts

Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.

Synopsis

Dr. Alharbi starts by describing how patients get referred to him, mainly due to end stage renal disease, chronic obstruction, and the need for dialysis access. Additionally, some patients seek access for central lines, and others have acute obstructions due to malignancies. Depending on the patient’s clinical condition, comorbidities, upcoming medical procedures, and anatomy, he will then decide if the patient is an appropriate candidate for SVC recanalization and obtain a CT scan. This imaging guides further decision-making on whether to access the obstruction from the internal jugular or brachiocephalic vein. The CT also helps him think about potential complications, such as cardiac tamponade in an obstruction close to the heart and pulmonary edema in all recanalizations. These risks are communicated to each patient accordingly.

Prior to starting the procedure, Dr. Alharbi ensures that there are multiple access sites prepared, including neck, bilateral arms, and femoral access. He also ensures that there are tools that he is comfortable using and a support team in place. A colleague will usually help him by obtaining femoral access and placing a target snare distal to the obstruction.

Dr. Alharbi walks us through a typical case. First he slowly advances a Chiba needle towards the target. His choice in sheath length depends on the length of the occlusion and the access point. A longer occlusion accessed through the brachiocephalic vein requires a longer sheath than a short occlusion accessed through the internal jugular vein. Next, we discuss stent sizing. Dr. Alharbi notes that it is preferable to oversize, to prevent stagnation of flow. In short occlusions, he uses bare self-expandable stents. In longer occlusions or cancer patients, he uses covered stents since there is more precise deployment.

The post-procedure anticoagulation regimen usually includes heparin and an antiplatelet agent for 2-3 weeks. Then, patients are switched to apixaban for 6 months. Beyond this, patients are either taken off of anticoagulation if they are asymptomatic and there is good SVC inflow, or reverted back to their preexisting anticoagulation regimen that they had due to other comorbidities.

Resources

PAIRS 2023:
https://pairscongress.com/

Dr. Abdulaziz Alharbi Twitter:
https://twitter.com/DrAlHarbiA_Aziz

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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