A novel technique to restore access in patients with central venous occlusion using the Surfacer® Inside-Out® Access Catheter System

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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Overview of the safety and efficacy of the Surfacer® Inside-Out® Access Catheter System for obtaining central venous access in patients with thoracic central venous obstructions

Expert Review of Medical Devices ◽

10.1080/17434440.2020.1825938 ◽

2020 ◽

Vol 17 (9) ◽

pp. 937-944

Author(s):

Mahmood K. Razavi

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Safety And Efficacy ◽

Catheter System ◽

Inside Out

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Conversion of Arterio-Venous Access of Hemodialysis to Arterio-Arterial Access for Treatment of Venous hypertension with Central Venous Occlusion

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.03.010 ◽

2021 ◽

Author(s):

Tamer Khafagy ◽

Mohamed S. Abdelgawad ◽

Ahmed Eleshra ◽

Samer Regal ◽

Ehab Saad

Keyword(s):

Venous Access ◽

Venous Occlusion ◽

Venous Hypertension ◽

Central Venous ◽

Arterial Access ◽

Central Venous Occlusion

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Life-threatening emergencies

Oxford Handbook of Emergency Medicine ◽

10.1093/med/9780199589562.003.0002 ◽

2012 ◽

pp. 40-61

Author(s):

Jonathan P. Wyatt ◽

Robin N. Illingworth ◽

Colin A. Graham ◽

Kerstin Hogg ◽

Michael J. Clancy ◽

...

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Central Venous Access ◽

Treatment Algorithm ◽

Advanced Life Support ◽

Venous Access ◽

Central Venous ◽

Life Threatening

Anaphylaxis 42 Treatment algorithm for adults with anaphylaxis 44 Choking 45 Cardiac arrest 46 In-hospital resuscitation algorithm 47 Adult basic life support 48 Cardiac arrest management 50 Advanced life support algorithm 52 Notes on using the advanced life support algorithm 53 Post-resuscitation care 54 Central venous access ...

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Life-threatening emergencies

Oxford Handbook of Emergency Medicine ◽

10.1093/med/9780198784197.003.0002 ◽

2020 ◽

pp. 43-65

Author(s):

Jonathan P. Wyatt ◽

Robert G. Taylor ◽

Kerstin de Wit ◽

Emily J. Hotton ◽

Robin J. Illingworth ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Cardiac Arrest ◽

Life Support ◽

Central Venous Access ◽

Advanced Life Support ◽

Venous Access ◽

Central Venous ◽

Sick Patient ◽

Life Threatening

This chapter in the Oxford Handbook of Emergency Medicine examines all aspects of life-threatening emergencies encountered in the emergency department (ED). It examines anaphylaxis and its treatment, as well as choking. It discusses cardiac arrest and its management, as well as in-hospital resuscitation and adult Basic and Advanced Life Support algorithm use, post-resuscitation care, and central venous access. It explores recognition of the sick patient, sepsis, and shock.

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Use of the Surfacer® Inside-Out® Catheter Access System to Obtain Central Venous Access in Dialysis Patients With Thoracic Venous Obstructions: Single-Center Series

Vascular and Endovascular Surgery ◽

10.1177/1538574420980604 ◽

2020 ◽

pp. 153857442098060

Author(s):

Noemi Galas ◽

Robert Shahverdyan

Keyword(s):

Central Venous Access ◽

Kidney Injury ◽

Venous Access ◽

Iliac Vein ◽

Dialysis Patients ◽

Central Venous ◽

Access System ◽

Cardiac Decompensation ◽

History Of ◽

Inside Out

Background: Thoracic central venous obstruction (TCVO) is a common condition which can impact the ability to achieve central venous access (CVA) in patients on hemodialysis. The Surfacer® Inside-Out® Catheter Access System is designed to enable repeated right-side central venous access in patients with TCVO. Methods: We retrospectively analyzed medical records of 10 dialysis patients who presented with TCVO and underwent the Inside-Out procedure with the Surfacer System to obtain CVA between 2017 and 2020. Patient demographics, hemodialysis vascular access history, and procedural data were identified and analyzed. The mean patient age was 62.4 ± 19.6 years (25.9-89.1 years) with 7 of the 10 patients being male. Eight patients (80.0%) were diagnosed with chronic kidney disease with time on hemodialysis ranging from 3 to 13 years. The remaining 2 required CVA to treat acute-on-chronic kidney injury due to septic shock. Patients in our series had a mean of 2.8 ± 1.6 previous catheters placed prior to the Surfacer procedure. Results: CVA was achieved in all 10 patients with 1 patient requiring a second attempt to achieve access due to the inability to initially traverse the iliac vein with the device, possibly due to a history of kidney transplantation. One multimorbid patient died shortly after the successful procedure, possibly due to cardiac decompensation. Mean total procedure time for the 7 patients having only dialysis catheter placement using the Surfacer device was 67.2 ± 19.1 minutes (49-103 minutes). The remaining 3 patients received a Hemodialysis Reliable Outflow (HeRO) graft in conjunction with the Inside-Out procedure. All vascular accesses functioned properly during the immediate time period following placement. No adverse events associated with the use of Surfacer device were encountered. Conclusions: Data presented from our patient series confirms the effectiveness of the Surfacer System to safely achieve CVA in dialysis patients with TCVOs with a history of multiple catheter placements.

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