Utility of the BeBack re-entry catheter to treat resistant cephalic arch occlusion in a haemodialysis patient: Case report and review of the literature

BACKGROUND: Cephalic arch stenosis is a common complication in haemodialysis patients with brachiocephalic arteriovenous fistula (AVF) that can lead to access dysfunction. For resistant lesions that fail conventional endovascular treatment, a possible salvage approach to avoid open surgery is via sharp recanalization using re-entry catheters. METHODS: We describe the unprecedented use of the BeBack re-entry catheter (Bentley InnoMed GmbH), previously the GoBack catheter (Upstream Peripheral Technologies), to overcome a recalcitrant cephalic arch occlusion by sharp recanalization in a 73-year-old female with thrombosed left brachiocephalic AVF that failed revascularization using conventional catheter and wire techniques. During the procedure, there was a contained perforation subcutaneously but the BeBack catheter was manoeuvred to re-enter into the axillary and subclavian vein. This was followed by balloon angioplasty and insertion of Viabahn (Gore Medical) stent grafts across the revascularized track. RESULTS: Completion angiography at end of the procedure showed smooth flow through the cephalic system without subcutaneous extravasation and our patient avoided the need for open surgical bypass. No immediate postoperative complication was encountered. CONCLUSIONS: Although the BeBack catheter has been predominantly used in difficult-to-treat lower limb chronic total occlusions, we have shown that it is also a potential feasible salvage option for sharp recanalization in the treatment of dysfunctional arteriovenous access.