Use of a Reentry Device for Endovascular Recanalization of Central Venous Occlusions Associated With Failing Hemodialysis Access
Bibliographic record
Abstract
INTRODUCTION: To evaluate the technical feasibility and safety of a reentry device for endovascular recanalization of central venous occlusions associated with dysfunctional arteriovenous fistulas. METHODS: Between January 2013 and December 2023, 20 patients (13 women; mean age, 61.1 years) with dysfunctional fistulas attributed to central venous occlusion underwent treatment using an Outback LTD reentry device. All patients had experienced unsuccessful recanalization attempts using conventional endovascular techniques. Symptoms included increased venous pressure during hemodialysis (N = 8), arm swelling (N = 8), absence of flow (N = 1), graft thrombosis (N = 2), and maturation failure (N = 1). The mean age of the fistulas was 56.1 months, and 11 patients had a history of angioplasty. An Outback LTD reentry device was used when conventional endovascular techniques were unsuccessful. FINDINGS: Occlusions were observed at the junction of the subclavian and innominate veins (N = 15) and in the right innominate vein (N = 2), subclavian vein (N = 1), and axillary vein of the arm (N = 2). The reentry device was introduced via the fistula (N = 11), femoral vein (N = 8), or internal jugular vein (N = 1). Technical success was achieved in 18 patients (90.0%), all of whom successfully underwent hemodialysis. Eight patients with arm swelling experienced symptom relief. In the 14 patients available for long-term follow-up, the mean intervention-free period was 5.0 months, and the mean functional period of the fistula, with or without subsequent endovascular treatment, was 23.0 months. No complications were observed. DISCUSSION: An Outback reentry device may be used for central venous occlusions when conventional techniques are unsuccessful.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".