Abstract: Objective   To investigate the efficacy and safety of endovascular intervention for refractory subclavian vein occlusion (SVO) in hemodialysis patients.  Methods  Clinical data of the 24 patients failed to recanalize the SVO using standard guidewire and catheter techniques between June 2019 and June 2021 in our department were retrospectively studied. They were categorized into two groups: 12 patients in group 1 undergone percutaneous transluminal venoplasty (PTV) via a blunt impingement technique, and 12 patients in group 2 undergone sharp needle recanalization. Technical success rate, fluoroscopy time in the procedure, perioperative complications, and patency rate were evaluated retrospectively.  Result  Comparison of the two groups reveals no significant difference in success rate (100% vs. 91.67%, Fisher exact test, P=0.400). The operation time (76.08±11.72min vs. 90.67±9.61min, t=3.333, P=0.003) and complication rate (8.34% vs. 58.34%, P=0.027) were significantly less in group 1 than in group 2 (P＜0.05). Mean occlusion length was significantly longer in group 2 than in group 1 (34.0±6.82mm vs. 25±6.99mm, t=3.191, P=0.004). A higher percentage of calcified lesions was found in group 2 (58.33% vs. 16.67%, P=0.019). During follow-up (median 12 months), the primary patency rates were 83.3% in group 1 and 75.0% in group 2 after the operation for 6 months, and were 58.3% in group 1 and 50.0% in group 2 after the operation for 12 months. There was no statistically significant difference in patency rate between the two groups (c2=0.682, P=0.409).  Conclusion  It is effective and safe for interventionalists to use the blunt impingement technique to treat chronic SVO refractory to traditional procedures. The sharp needle recanalization method can be used as supplementary means.

Key words: Blunt impingement, Sharp recanalization, Refractory central venous occlusion, Hemodialysis