The delivery of kidney care, particularly haemodialysis treatment, can result in substantial environmental impact through greenhouse emissions, natural resources depletion and waste generation. However, strategies exist to mitigate this impact and improve long term environmental sustainability for the provision of haemodialysis treatment. The nephrology community has begun taking actions to improve the environmental sustainability of dialysis, but much work remains to be done by healthcare professionals, dialysis providers and professional organisations.

Chronic central venous occlusion represents a challenge for upper body central dialysis access for both surgical and endovascular interventions. The Surfacer (Surfacer Inside‐Out Access Catheter System) is a novel technique that offers a device‐based solution over various physician‐modified techniques in salvaging exhausted right‐sided neck veins for catheter placement. We report a retrospective series of four cases in which this system is used to gain upper body venous access from a single center in Singapore. This report seeks to integrate the understanding of the technical aspects of a new inside‐out device and its utility in recanalization of occluded right‐sided neck veins as it relates to Asian patients.

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