Abstract: SA-PO969

Gaining Central Venous Access Safely and Quickly in Patients with Occlusion of the Upper Central Veins with a Novel Device Using an Inside-Out Approach

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Reindl-Schwaighofer, Roman, Medical University of Vienna, Vienna, Austria
  • Sengoelge, Gurkan, Medical University of Vienna, Vienna, Austria
Background

Left-sided and subclavian central accesses cause the highest rate of central venous thromboses and occlusions. Exhaustion of vascular access options caused by thoracic central venous occlusion (TCVO) adds to dialysis-related morbidity and mortality. We report the first case series of a novel device, the Surfacer, for repeated right-sided central venous access in patients with TCVO.

Methods

The Surfacer consists of a metal pole with a sharp wire inside attached to a handle. The procedure is performed on an outpatient basis using local anesthesia under fluoroscopy as follows: A 10F sheath is introduced up to the TCVO over a standard guidewire from the right femoral vein. After removal of this wire, the 7F metal pole of the Surfacer is introduced through the sheath to the TCVO and pushed through until its tip has passed the clavicle. The sharp wire is then released using a plunger at the handle from the tip of the Surfacer piercing the skin inside out in the right supraclavicular region. This now serves as a guidewire for a central venous access.
We analyzed success rate, duration of procedure and complications of all Surfacer cases performed at the Department of Nephrology, Medical University of Vienna between July 2016 and April 2018.

Results

The Surfacer procedure was considered in 37 cases. Following CT angiography, four patients did not qualify because of complete occlusion of either right external iliac vein or inferior or superior vena cava. The majority of patients had a TCVO type 3 with occlusion of both brachiocephalic veins but a patent azygous vein. The procedure had a 97% success rate (32 out of 33; one patient had a massive scoliosis which blocked the passage of the device). The mean intervention time was 14 min. There were no Surfacer related complications defined as early infections, bleeding, hematoma or pericardial effusions. In five patients the procedure was repeated due to infection or dysfunction > 3 months after initial placement.

Conclusion

This is the first case series of a novel device for inside-out placement of central venous access in patients with TCVO requiring dialysis. The procedure is highly successful, safe and repeatable allowing for an “always right, never subclavian” approach.