Use of the Surfacer® Inside-Out® access catheter system to place permanent dialysis access via hemodialysis reliable outflow (HeRO) graft

Abstract

IntroductionCentral venous occlusion (CVO) poses a great challenge to maintain dialysis access for end-stage renal disease patients. In patients with exhausted peripheral vascular access from central venous occlusion, currently available solutions such as central venous catheters, angioplasty, and lower extremity access provide limited benefits. MethodsWe describe the use of the Surfacer® Inside-Out® Access Catheter System from right femoral vein to cross a central venous occlusion (CVO) that had failed crossing from the internal jugular vein. The needlewire of the Surfacer system was retrieved extravascularly at the base of the neck. Instead of a central venous catheter, a Hemodialysis Reliable Outflow (HeRO) Graft was placed in the right atrium and joined with right brachial artery at the same setting. ResultsWe describe a technique for placing upper extremity Hemodialysis Reliable Outflow (HeRO) grafts in patients with severe superior vena cava occlusion via Surfacer® Inside-Out® Access Catheter System. The procedure was technically successful, and on postoperative day 1, the patient had flow volumes greater than 1000 cc/min in the HeRO graft. ConclusionsUsing the Surfacer® Inside-Out® Access Catheter System to cross central venous occlusion to place Hemodialysis Reliable Outflow (HeRO) grafts rather than tunneled dialysis catheters is safe and technically feasible.