Salvage of exhausted neck access using a novel inside‐out device in dialysis‐dependent patients

Abstract

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.

Efficacy and safety associated with the use of the Surfacer® Inside-Out® Access Catheter System: Results from a prospective, multicenter Food and Drug Administration–approved Investigational Device Exemption study

“…Patient monitoring was limited to 7-day post-procedure per study definitions and requirements. As in other series, 10–12 there was a limited number of patients with type 4 obstructions in this patient population. The distribution of the obstruction types treated in the present study is reflective of the epidemiology of type 4 lesions and hence enrollment in this study is representative of the general population of patients with TCVO who need CVC.…”

“…The results from the present study are consistent with those reported in conjunction with the use of the Surfacer device in other retrospective patient series. 10–12 Reindl-Schwaighofer et al 10 recently reported on a larger series of patients where the device was used successfully to establish CVA in 38 of 39 (97%) attempted procedures in hemodialysis patients with TCVO. This included seven patients in which the Surfacer procedure was repeated due to failure of the CVC and inability to change out the catheter during the study observation.…”

“…The device permits entry and placement of CVCs for patients with upper body venous obstructions that preclude conventional CVA by using the percutaneous, endovascular inside-out CVA placement technique. 10–12 In this article, we report the results from a prospective, multicenter, single-arm study designed to evaluate the safety and efficacy of the Surfacer device in patients with TCVO.…”

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

“…The right external jugular vein has been proposed as the second-best approach (Yevzlin, Chan, & Gimelli, 2008). More recently, an interesting alternative option became available, which allows the CVC to be placed in thrombosed right brachiocephalic or right internal jugular veins through a femoral vein approach with inside-out vein puncture (Surfacer ® device, Bluegrass Vascular Technologies, San Antonio, TX) (Ebner, Gallo, Cetraro, Gurley, & Minarsch, 2013;Quek, Tan, Tan, & Pua, 2019). Avoiding cannulation of the subclavian veins and the LIJV in hemodialysis patients with future possibilities of establishing arterio-venous dialysis access should be strongly considered a priority.…”

Percutaneous access of the superior vena cava in patients with bilateral jugular-subclavian vein occlusion using wire-target access for placement of tunneled hemodialysis catheters: An important new tool for gaining upper body vascular access

“…Inside-out vascular access technology (Surfacer, Merit Medical) is currently in clinical trials in the United States and is not approved for general use, although it has gained CE Mark, and results from a small European study demonstrating its efficacy have been published. 8 CONCLUSIONS TDC placement in the right side of the heart in adults with bilateral upper extremity central venous occlusion can be challenging. The wire-target SVC access technique is a simple, safe, and effective percutaneous alternative for obtaining upper body central vascular access using standard real-time fluoroscopic interventional techniques in these patients with difficulty in access.…”