Salvage of exhausted neck access using a novel inside-out device in dialysis-dependent patients

Chronic central venous occlusion represents a challenge for upper body central dialysis access for both surgical and endovascular interventions. The Surfacer (Surfacer Inside-Out Access Catheter System) is a novel technique that offers a device-based solution over various physician-modified techniques in salvaging exhausted right-sided neck veins for catheter placement. We report a retrospective series of four cases in which this system is used to gain upper body venous access from a single center in Singapore. This report seeks to integrate the understanding of the technical aspects of a new inside-out device and its utility in recanalization of occluded right-sided neck veins as it relates to Asian patients.