目的  评估房间隔穿刺针锐性再通技术作为传统导丝再通失败后的补救措施，在治疗血液透析患者右侧头臂静脉慢性完全闭塞(chronic total occlusion，CTO)中的疗效与安全性。 方法  回顾性分析2018年1月—2024年12月四川大学华西医院收治的53例右侧头臂静脉CTO患者。所有患者均先行传统导丝再通，对其中34例失败者采用房间隔穿刺针行补救性再通。比较2组患者的技术成功率、并发症发生率及手术后3、6、12个月的初级与次级通畅率。 结果  传统再通组的技术成功率为100.0%(19/19)，房间隔穿刺组为94.1%(32/34)，2组间比较差异无统计学意义(P=0.540)。2组并发症发生率分别为10.5%和17.6%，组间比较差异无统计学意义(P=0.704)。采用Kaplan-Meier法估计通畅率并行Log-rank检验比较，结果显示2组在手术后3、6、12个月的初级通畅率(传统再通组：89.47%、78.95%、57.89%；穿刺组：91.18%、79.42%、58.82%，c2=0.902，1.127，0.762，P=0.371，0.871，0.293)及次级通畅率(传统再通组：84.21%、73.68%、68.42%；穿刺组：94.12%、85.29%、61.76%，c2=0.502、0.927、1.156，P=0.153、0.362、0.542)比较差异均无统计学意义。房间隔穿刺组的闭塞段长度长于传统再通组[(28.72±5.13)mm比(23.31±6.82)mm，t=3.213，P＜0.001]。 结论  对于传统导丝再通失败的右侧头臂静脉CTO患者，房间隔穿刺针锐性再通是一种有效且安全的技术手段，作为传统导丝再通失败后的补救措施，其近期与中期通畅率与传统再通成功病例相近，尤其适用于长段、纤维钙化性复杂病变。

Objective To evaluate the efficacy and safety of sharp recanalization using a trans-septal needle as a salvage technique for chronic and total occlusion (CTO) of the right brachiocephalic vein in hemodialysis patients after failure of conventional guidewire recanalization.  Methods  A retrospective analysis was conducted on 53 hemodialysis patients with right brachiocephalic vein CTO treated at West China Hospital of Sichuan University between January 2018 and December 2024. All patients initially underwent conventional guidewire recanalization, and 34 of the 53 patients with failed conventional recanalization subsequently received salvage sharp recanalization using a trans-septal needle. Technical success rate, complication rate, and primary and secondary patency rates at 3, 6, and 12 months were compared between the two groups.  Results  The technical success rate was 100.0% (19/19) in the conventional recanalization group and 94.1% (32/34) in the trans-septal needle group, with no significant difference between the two groups (P=0.540). The complication rates were 10.5% and 17.6%, respectively, also showing no significant difference (P=0.704). Patency rates were estimated using the Kaplan-Meier method and compared with the log-rank test. No significant differences were observed in primary patency rates at 3, 6, and 12 months (conventional group: 89.47%, 78.95%, and 57.89%; trans-septal needle group: 91.18%, 79.42%, and 58.82; χ²=0.902, 1.127, and 0.762, respectively) or in secondary patency rates (conventional group: 84.21%, 73.68%, and 68.42%; trans-septal needle group: 94.12%, 85.29%, and 61.76; χ²=0.502, 0.927, and 1.156, respectively), with all P values ＞0.05. Notably, the occlusion length was significantly longer in the trans-septal needle group than in the conventional recanalization group (28.72±5.13mm vs. 23.31±6.82mm, t=3.213, P＜0.01).  Conclusion  For hemodialysis patients with right brachiocephalic vein CTO in whom conventional guidewire recanalization fails, sharp recanalization using a trans-septal needle is an effective and safe salvage technique. Its short- and mid-term patency outcomes are comparable to those achieved in patients with successful conventional recanalization, and it may be particularly suitable for long-segment, fibrotic, or calcified complex lesions.