095 - Inside-Out: A Novel Method for Central Venous Recanalization Using The Surfacer
Amir Noor, MD – Interventional Radiology Attending, NYU Langone; Jorge Tirado, MD – Interventional Radiology Attending, Interventional Radiology, Northwell Health; Jonathan Penner, MD – Interventional Radiology Fellow, Northwell Health
Purpose: Review the causes, patterns and symptoms of thoracic central vein obstruction (TCVO) and discuss the importance of preserving access in patients with chronically occluded central veins. We will illustrate a case demonstrating the successful use of the Surfacer, a novel venous recanalization and catheter system to provide access for a patient with chronic TCVO.
Material and Methods: This is a case presentation of a 26 year old female with a past medical history of systemic lupus erythematosus and end stage renal disease on chronic catheter dependent hemodialysis who presented with bacteremia requiring tunneled right internal jugular (RIJ) catheter removal. Computed tomography (CT) venous phase imaging demonstrated TCVO with occlusion of the superior vena cava (SVC) to the level of the azygous vein. Given the patient’s age, the decision was made to reattempt thoracic venous access to preserve alternative venous access points (femoral, hepatic, lumbar, etc.)
Results: Utilizing the Surfacer device through right femoral vein access, sharp recanalization of the SVC to the RIJ was performed with inside-out deployment of a nitinol wire through the skin of the right neck. A tunneled dialysis catheter was placed over that wire and advanced into the cavoatrial junction.
Conclusions: There is significant increased morbidity associated with chronic TCVO and preserving thoracic venous access improves long term outcomes for catheter dependent dialysis patients. The Surfacer device is a novel method for preserving thoracic venous access.