Modified Inside-Out Technique for Continued Use of Chronically Occluded Upper Central Veins

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Technology

Background:

• Chronic central venous occlusions pose significant challenges for establishing reliable venous access.
• Conventional methods may be insufficient or carry high risks in patients with complex venous anatomy.

Purpose of the Study:

• To describe and evaluate a novel 2-step, inside-out procedure for achieving central venous access.
• To assess the efficacy of this technique in patients with chronic central venous occlusions.

Main Methods:

• A 2-step, inside-out approach involving blunt cephalad dissection with a curved metal cannula and guidewire.
• Percutaneous puncture of an open snare from a right supraclavicular approach, followed by tract dilation.
• Insertion of a tunneled central venous catheter.

Main Results:

• Successful placement of a tunneled central venous catheter in all 9 patients treated.
• The technique effectively created venous access despite pre-existing central venous occlusions.

Conclusions:

• The described 2-step, inside-out technique is effective for establishing central venous access in the presence of chronic venous occlusions.
• Further clinical evaluation is warranted to confirm the long-term efficacy and safety of this approach.