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SIR Publishes First Clinical Practice Guidelines for TCVO

The first clinical practice guidelines for thoracic central vein obstruction (TCVO) were recently published online in the Journal of Vascular and Interventional Radiology(JVIR). The guidelines will also be available in JVIR's April 2018 print issue.

Central venous occlusion is a significant, largely underestimated, and costly problem. An estimated 2 million people worldwide are currently either receiving treatment with dialysis or a kidney transplant, many of whom rely on central venous catheters (CVCs) to receive this lifesaving treatment. Despite being widely utilized, 40% of hemodialysis patients with CVCs develop a central venous obstruction, which, if left untreated, can lead to increased patient morbidity, reduced quality of life, and increased provider costs.

A lack of universal reporting standards for TCVO prevents clinicians from fully recognizing its prevalence, optimal treatment options, and resulting outcomes. TCVO is a complex condition, often requiring a team of specialists to identify, manage, and treat. The Central Vein Work Group, composed of representatives from IR, vascular surgery, nephrology, and several other related specialties, was founded to address this problem. Its goal is to establish a standard for describing TCVO patterns and resulting clinical consequences, with the aim of guiding best practices and reducing incidence of TCVO.

"These guidelines represent a multidisciplinary interest to promote sustainable vascular access," says Bart Dolmatch, MD, an interventional radiologist at the Palo Alto Medical Foundation in Mountain View, California. "They organize manifestations of TCVO in a way that now gives clinicians access to a common language to ensure alignment and management across specialties, leading to better coordinated care."

Societal endorsement of the TCVO clinical practice guidelines include the American Society of Diagnostic and Interventional Nephrology, British Society of Interventional Radiology, Canadian Interventional Radiology Association, Heart Rhythm Society, Indian Society of Vascular and Interventional Radiology, Vascular Access Society of the Americas, and Vascular Access Society of Britain and Ireland.

"We are very pleased with the workgroup's establishment of these clinical practice guidelines for thoracic central vein obstruction," says Gabriele Niederauer, PhD, CEO and president of Bluegrass Vascular Technologies, a private medical technology company. "Widespread endorsement of these standards is a life-changing step forward for a growing population of patients requiring vascular access for vital treatments, who currently have limited options due to obstructed upper body access."