Azygos Vein Central Venous Access in a Patient with Thoracic Central Venous Obstruction

Purpose: Thoracic central venous obstruction is commonly associated with the use of central venous catheters. The Surfacer System to Facilitate Access in Venous Occlusions Study was an Food and Drug Administration–approved US Investigational Device Exemption study designed to evaluate the performance and safety of the Surfacer System when used to facilitate central venous access in patients with thoracic central venous obstruction. Methods: Thirty patients were enrolled in this prospective, multicenter, single-arm study between December 2017 and May 2019. Device performance and adverse events were collected peri-procedurally and at discharge. Enrollment included 15 female and 15 male subjects with a mean age of 55.5 ± 12.9 (range: 30–79) years. Twenty-eight patients (93.3%) required central venous access for hemodialysis access. Locations of thoracic central venous obstruction were graded from 1 to 4 based on severity and extension of venous occlusions. Seven patients (23.3%) had type 1, 6 (20.0%) type 2, 16 (53.3%) type 3, and 1 (3.3%) type 4 obstruction. Results: Successful central venous catheter placement was achieved in 27 of 30 patients (90.0%). The procedure was discontinued in three (10.0%) due to tortuous anatomy discovered intraprocedurally. All 27 patients with successful CVC placement achieved adequate catheter patency and tip positioning with a mean overall procedural time and time to achieve central venous access with the Surfacer System being 44.1 ± 30.6 and 19.1 ± 25.1 min, respectively. There were no device-related adverse events or catheter malposition. Conclusion: The results of the SAVEUS Study confirm the safety and efficacy of the Surfacer System and the Inside-Out procedure when used for the placement of right-sided central venous access in patients with thoracic central venous obstruction.

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The Surfacer® Inside-Out® Access System for right-sided catheter placement in dialysis patients with thoracic venous obstruction

The Journal of Vascular Access ◽

10.1177/1129729819867547 ◽

2019 ◽

Vol 21 (4) ◽

pp. 411-418 ◽

Cited By ~ 4

Author(s):

Dirk M Hentschel ◽

Laura Minarsch ◽

Félix Vega ◽

Adrian Ebner

Keyword(s):

Central Venous Access ◽

Patient Characteristics ◽

Low Complexity ◽

Venous Access ◽

Catheter Placement ◽

Dialysis Patients ◽

Venous Obstruction ◽

Central Venous ◽

The Right ◽

Central Venous Obstruction

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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Azygos vein erosion: A potential complication of central venous access

Journal of Pediatric Surgery Case Reports ◽

10.1016/j.epsc.2017.05.013 ◽

2017 ◽

Vol 24 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

David P. Mysona ◽

Randi L. Lassiter ◽

Kenneth C. Walters ◽

Walter L. Pipkin ◽

Robyn M. Hatley

Keyword(s):

Central Venous Access ◽

Azygos Vein ◽

Venous Access ◽

Potential Complication ◽

Central Venous

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Thoracoscopic-guided Azygos vein Catheterization and Port Implantation in a Child with End-stage Central Venous Access

The Journal of Vascular Access ◽

10.5301/jva.5000435 ◽

2015 ◽

Vol 16 (5) ◽

pp. e97-e98

Author(s):

Tarik Umutoglu ◽

Gokhan Gundogdu ◽

Ufuk Topuz ◽

Mefkur Bakan

Keyword(s):

Central Venous Access ◽

Azygos Vein ◽

Venous Access ◽

Central Venous ◽

Port Implantation ◽

End Stage ◽

Vein Catheterization

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Upper Extremity Impedance Plethysmography in Patients with Venous Access Devices

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648910 ◽

1994 ◽

Vol 72 (04) ◽

pp. 540-542 ◽

Cited By ~ 8

Author(s):

McDonald K Horne ◽

Donna Jo Mayo ◽

Richard Alexander ◽

Elizabeth P Steinhaus ◽

Richard C Chang ◽

...

Keyword(s):

Cancer Patients ◽

Upper Extremity ◽

Central Venous Access ◽

Venous Access ◽

Impedance Plethysmography ◽

Venous Obstruction ◽

Central Venous ◽

Venous Outflow ◽

Complete Obstruction ◽

Venous Access Devices

SummaryCentral venous access devices (VADs) are often associated with thrombotic obstruction of the axillary-subclavian venous system. To explore the accuracy of impedance plethysmography (IPG) in identifying this complication we performed IPG on 35 adult cancer patients before their VADs were placed and approximately 6 weeks later. At the time of the second IPG the patients also underwent contrast venography of the axillary-subclavian system. The venograms revealed partial venous obstruction in 12 patients (34%) and complete obstruction in two (5.7%). Although the IPG results from venographically normal and abnormal patients overlapped extensively, mean measurements of venous outflow were significantly lower in the patient population with abnormal venograms (P = 0.052 for Vo; P = 0.0036 for Vo/Vc). In our hands, therefore, upper extremity IPG cannot be used to make clinical decisions about individual patients with VADs, but it can distinguish venographically normal and abnormal populations.

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