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Bai Y, Liang S, Vachharajani TJ, An N, Xu M, Zhou Z, Li H. Feasibility and safety of guidewire-balloon entrapment technique for recanalization of thoracic central vein occlusion in hemodialysis patients. J Vasc Access 2023; 24:1438-1444. [PMID: 35443827 DOI: 10.1177/11297298221092745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the feasibility and safety of Guidewire-Balloon Entrapment Technique (GBET) for the recanalization of thoracic central vein occlusions (TCVOs) in hemodialysis patients. METHODS A retrospective observational study was conducted using data from 28 patients who required the establishment or maintenance of hemodialysis access and were treated with GBET for the recanalization of right-sided TCVOs from January 2017 to April 2021. Of the patients, 27 required tunneled cuffed catheter (TCC) placement or exchange, and 1 had an outflow tract occlusion of the Brescia-Cimino radio cephalic arteriovenous fistula (AVF). RESULTS A total of 26 patients successfully underwent TCC exchange and placement using GBET; 1 patient underwent successful recanalization of an occlusion of the outflow tract of the right Brescia-Cimino AVF; and 1 patient underwent successful TCC placement in the left internal jugular vein (LIJV) after the failure of TCC placement in the right internal jugular vein (RIJV). The success rate for GBET was 27/28 (96.43%), and there were no major complications. CONCLUSION GBET is a safe and effective method for the recanalization of right-sided TCVOs, especially for TCC exchange and placement, and can be used as a safe and easy approach for TCVO recanalization.
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Affiliation(s)
- Yafei Bai
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Shuntian Liang
- Department of Comprehensive Intervention of Southern Medical University of China, Guangzhou, Guangdong, China
| | - Tushar J Vachharajani
- Department of Kidney Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Na An
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Mingzhi Xu
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Zhongxin Zhou
- Department of Comprehensive Intervention of Southern Medical University of China, Guangzhou, Guangdong, China
| | - Hong Li
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
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Choi TJ, Carrato KA, Sabri SS, Tabori NE, Sivananthan G. Balloon-Targeted Extra-Anatomic Sharp Recanalization Technique to Re-establish Supraclavicular Vascular Access. J Vasc Interv Radiol 2023; 34:1676-1679. [PMID: 37414213 DOI: 10.1016/j.jvir.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
A balloon-targeted extra-anatomic sharp recanalization (BEST) technique was investigated to re-establish supraclavicular vascular access in patients with central venous occlusion. Query of the authors' institution's database yielded 130 patients who underwent central venous recanalization. Of these, a retrospective review of 5 patients with concurrent thoracic central venous and bilateral internal jugular vein occlusions who underwent sharp recanalization using the BEST technique from May 2018 to August 2022 was performed. Technical success was achieved in all cases without major adverse events. Four (80%) of the 5 patients underwent hemodialysis reliable outflow (HeRO) graft placement using the newly established supraclavicular vascular access.
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Affiliation(s)
- Taedo J Choi
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Kaitlin A Carrato
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Saher S Sabri
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Nora E Tabori
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Gajan Sivananthan
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC.
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Kittitirapong N, Jeraja B, Pootracool P, Pornwaragorn C, Tepsamrithporn G, Sitthilor S, Horsirimanont S. Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion. J Vasc Surg Cases Innov Tech 2022; 8:885-893. [PMID: 36568957 PMCID: PMC9772498 DOI: 10.1016/j.jvscit.2022.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Femoral tunneled cuffed catheters (TCCs) can provide long-term hemodialysis access for patients with exhausted upper extremity access sites due to thoracic central venous occlusion. However, the use of femoral vein catheters (FVCs) has reportedly been associated with the risk of infection, malfunction, and discomfort. An inside-out technique will facilitate chest TCC placement by intentional retrograde extravascularization of the proximal occluded venous stump into the mediastinum. Next, the wire and small catheter are exteriorized to the skin at the base of the neck with a small skin incision. Then, the hemodialysis catheter is railed back down to the right atrium. With this technique, we placed the tip of the catheter into intrathoracic superior vena cava or brachiocephalic vein. In the present study, we compared the catheter patency of the inside-out technique vs a standard approach for FVC placement. Methods The present randomized controlled trial was conducted from May to December 2020. We included 22 patients requiring long-term hemodialysis with failed recanalization of thoracic central venous occlusion. The patients were randomized into the surgical inside-out (S-inside-out) group and FVC group. Results The S-inside-out and FVC groups included 10 and 12 patients, respectively. All 22 patients had undergone successful catheter placement. Catheter survival function was significantly higher for the S-inside-out group than for the FVC group (100% vs 50%, respectively; P = .017). In addition, the EQ-5D utility score was significantly better for the S-inside-out group (P = .008). Four cases of catheter infection occurred in the FVC group, but no catheter infection was found in the S-inside-out group. Procedural-related complications occurred in two patients; one case each of hemothorax and stroke in the S-inside-out group. Conclusions Use of the S-inside-out technique facilitated upper chest TCC placement for hemodialysis patients with exhausted access sites. This technique provided better catheter survival function, a better quality of life, and a lower infection rate, which outweighed the procedure risk.
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Affiliation(s)
- Nutsiri Kittitirapong
- Division of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | | | - Piyanut Pootracool
- Division of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Chaowanun Pornwaragorn
- Division of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Gorawee Tepsamrithporn
- Division of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Surasit Sitthilor
- Nursing Service Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Suthas Horsirimanont
- Division of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand,Correspondence: Suthas Horsirimanont, MD, Division of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Rd, Bangkok 10400, Thailand
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Benfor B, Chinnadurai P, Peden EK. Advanced intraoperative imaging guidance for inside-out central venous recanalization using a novel catheter access system. J Vasc Surg Venous Lymphat Disord 2022; 10:1334-1342.e1. [PMID: 35940445 DOI: 10.1016/j.jvsv.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/27/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The novel Surfacer Inside-Out recanalization technique facilitates right-sided central venous access in occluded vessels but carries a risk of arterial and pleural injuries. This article demonstrates how an advanced intraoperative imaging protocol can help to avoid these potential complications. METHODS This retrospective review included patients undergoing the Surfacer Inside-Out central venous recanalization procedure between December 2017 and October 2021. The study sample comprised patients included in the SAVE-US trial at our site as well as patients treated after US Food and Drug Administration approval of the device. All procedures were performed using intraoperative cone-beam computed tomography (CBCT) angiography to map out the trajectory of the device through the mediastinum and supraclavicular space with fusion imaging for guidance. Procedures were aborted if CBCT findings predicted injury to arterial or respiratory structures. The intraoperative coronal and sagittal orientation of the device was compared to preoperatively predicted trajectory. RESULTS A total of 17 procedures were performed in 16 patients with end-stage renal disease and a mean age of 61 ± 11 years. Most patients presented a type 3 central venous occlusion (9/15). Successful recanalization was achieved in 14 of the 17 cases (82.4%) with no intraoperative complications. The procedure had to be aborted in 3 of the 17 cases based on intraoperative CBCT findings, which projected the device to perforate the right pleural space in one patient, the trachea and right subclavian artery in another, and the innominate artery in the third patient. The total radiation dose per procedure was 753 ± 346 mGy and the mean procedural time was 101.6 ± 29.7 minutes. A median of 2 (range, 1-5) intraoperative CBCT scans were performed per patient and accounted for 70% of the total radiation dose. Statistical analysis showed intraoperative CBCT findings to differ significantly from preoperative predicted values. CONCLUSIONS The nonsteerable and penetrating nature of the Surfacer device may lead to serious complications when performed under fluoroscopic guidance alone. Intraoperative CBCT with fusion overlay enhances the safety and effective use of this device and inside out crossing technique.
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Affiliation(s)
- Bright Benfor
- Department of Vascular Surgery, Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX.
| | | | - Eric K Peden
- Department of Vascular Surgery, Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
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Baetens TR, Rotmans JI, van der Meer RW, van Rijswijk CS. A novel technique to restore access in patients with central venous occlusion using the Surfacer ® Inside-Out ® Access Catheter System. J Vasc Access 2020; 21:778-782. [PMID: 32148159 PMCID: PMC7477775 DOI: 10.1177/1129729820909730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Exhausted central venous access is a potentially life-threatening situation for patients dependent on haemodialysis. If standard guidewire recanalisation fails, unconventional venous access or central venous needle recanalisation can be considered but are often associated with higher rates of complications and/or dysfunction. Here, we report about two patients treated successfully with the Surfacer® Inside-Out® Access Catheter System (Bluegrass Vascular Technologies, San Antonio, TX, USA) to achieve transmediastinal central venous access.
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Affiliation(s)
- Tarik R Baetens
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joris I Rotmans
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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Hentschel DM, Minarsch L, Vega F, Ebner A. The Surfacer® Inside-Out® Access System for right-sided catheter placement in dialysis patients with thoracic venous obstruction. J Vasc Access 2019; 21:411-418. [DOI: 10.1177/1129729819867547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Thoracic central venous obstruction is a common clinical complication in dialysis patients utilizing hemodialysis catheters. Thoracic central venous obstruction can lead to inability to utilize affected veins for catheter placement and sequential use of less preferred alternative venous access sites. The latter can affect the ability to create and/or mature permanent arteriovenous access and contribute to the future loss of thoracic veins for venous access. While alternative procedures exist for gaining venous access in patients who have exhausted routine venous access options, these procedures are complex, time-consuming, and associated with high patient risk. The Surfacer System provides a new approach in patients with right-sided thoracic central venous obstruction, enabling the ability to establish repeated access from the right side of the neck to the right atrium. Methods: We describe the use of the Surfacer System to facilitate placement of hemodialysis catheters in a series of nine patients with thoracic central venous obstruction involving one or more central veins. Patient characteristics and procedure-related outcomes were recorded for all patients. Results: Central venous access was successfully achieved in eight of nine patients using the Surfacer System. Significant venous tortuosity resulted in the inability to achieve venous access in one patient and prolonged procedural time to achieve access in another patient. The mean time required for Surfacer-related procedural steps and associated fluoroscopy time in the remaining seven patients was 13.3 and 3.7 min, respectively. Conclusion: The Surfacer System provides an efficient low-complexity alternative for gaining repeated right-sided central venous access in hemodialysis patients with obstructed thoracic veins.
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Affiliation(s)
| | | | - Félix Vega
- Preclinical Consultation, San Francisco, CA, USA
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Freeman BM, Tingen JS, Cull DL, Carsten CG. The inside-out technique for tunneled dialysis catheter placement with central venous occlusion. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:350-355. [PMID: 31334416 PMCID: PMC6624247 DOI: 10.1016/j.jvscit.2019.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Abstract
The “inside-out” technique eliminates the need for subclavian or femoral catheter placement by placing a supraclavicular catheter via a percutaneous femoral vein access. Few reports of its use in vascular surgery exist. The purpose of this article is to describe our version of the technique and report results. Between 2016 and 2017, the inside-out technique was performed on eight patients. All patients had more than four prior access sites and bilateral internal jugular vein occlusion. The technical success rates were 100% with no periprocedural complications and success in achieving dialysis access. One patient required catheter replacement within 48 hours, one catheter was used as a bridge to Hemodialysis Reliable Outflow (Hemosphere, a Cryolife Inc Company, Eden Prairie, Minn) graft placement, and one patient died of sepsis unrelated to their catheter. Our data show the inside-out technique to be safe and effective, removes the need for subclavian or femoral catheter placement, and should be a component of treatment algorithms for complex dialysis patients, which is consistent with National Kidney Foundation's Kidney Disease Outcomes Quality Initiative recommendations.
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Quek LHH, Tan TSM, Tan GWL, Pua U. Salvage of exhausted neck access using a novel inside‐out device in dialysis‐dependent patients. Hemodial Int 2019; 23:E111-E114. [DOI: 10.1111/hdi.12770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/06/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Lawrence Han Hwee Quek
- Department of Diagnostic RadiologyTan Tock Seng Hospital Singapore Singapore
- Lee Kong Chian School of MedicineNanyang Technological University Singapore Singapore
| | - Tracy Suet Mun Tan
- Lee Kong Chian School of MedicineNanyang Technological University Singapore Singapore
- Department of Renal MedicineTan Tock Seng Hospital Singapore Singapore
| | - Glenn Wei Leong Tan
- Lee Kong Chian School of MedicineNanyang Technological University Singapore Singapore
- Department of General SurgeryTan Tock Seng Hospital Singapore Singapore
| | - Uei Pua
- Department of Diagnostic RadiologyTan Tock Seng Hospital Singapore Singapore
- Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
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