Related Experiment Video
Updated: Jan 2, 2026
Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
A Novel Inside-out Access Approach for Hemodialysis Catheter Placement in Patients With Thoracic Central Venous
Roman Reindl-Schwaighofer1, Vladimir Matoussevitch2, Wolfgang Winnicki1
1Department of Nephrology, Medical University of Vienna, Vienna, Austria.
Insights
The inside-out access (IOA) approach successfully established dialysis access in 97% of patients with thoracic central vein occlusions (TCVOs). This novel technique offers a promising solution for patients needing hemodialysis despite complex venous occlusions.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Left-sided central venous catheters (CVCs) and subclavian catheters frequently cause thoracic central vein occlusions (TCVOs).
- TCVOs complicate the placement of new CVCs, particularly for patients requiring hemodialysis.
- Existing methods for accessing the venous system in TCVO patients are limited.
Purpose of the Study:
- To assess the eligibility and success rate of the novel inside-out access (IOA) approach for establishing dialysis access in patients with TCVO.
- To evaluate the safety and efficacy of the IOA technique in a multicenter setting.
Main Methods:
- Retrospective observational study involving 36 patients with TCVO across three European vascular access centers.
- The IOA approach utilized a novel device advanced from the right femoral vein to gain access.
- Primary endpoint was the success rate of passing the TCVO; secondary endpoints included catheter patency and complications.
Main Results:
- 32 out of 36 patients (89%) were eligible for the IOA procedure.
- Dialysis access was successfully established in 38 out of 39 (97%) IOA implementations.
- The procedure had a median intervention time of 43 minutes, with no reported complications.
Conclusions:
- The inside-out access (IOA) approach is a highly successful and safe method for achieving right jugular vein access in patients with TCVO.
- This technique provides rapid vascular access for hemodialysis in challenging clinical scenarios.
- Further experience is needed to confirm the generalizability of these findings.
Rationale & Objective:
Left-sided internal jugular and all subclavian central venous catheters (CVCs) cause thoracic central vein occlusions (TCVOs) more often than right-sided internal jugular catheters. To enable right-sided CVC placement in patients with TCVO, an inside-out access (IOA) approach was established at 3 vascular access centers in Europe involving use of a novel IOA device advanced from the right femoral vein. In the current analysis, we assessed the eligibility and success rate of this IOA approach in a cohort of patients with TCVO requiring a tunneled dialysis catheter.
Study Design:
Retrospective multicenter observational study.
Setting & Participants:
36 patients with TCVO treated in Vienna, Austria; Oxford, England; or Cologne, Germany, who required hemodialysis access between July 2016 and June 2018.
Exposure:
Application of the IOA approach to gain vascular access.
Outcome:
The primary end point was the success rate of passing the TCVO to gain dialysis access using the IOA approach. Secondary end points were catheter patency at 3 months and procedure-related complications (early infections, bleeding, hematoma, and pericardial effusions).
Analytical Approach:
Descriptive statistics to characterize eligibility, success rate, and complications of the IOA approach.
Results:
36 patients with TCVO and history of multiple CVCs and arteriovenous fistulas were referred to the participating centers for vascular access. 32 (89%) patients were eligible for the IOA approach. 39 treatments were performed, with 7 patients undergoing the IOA procedure a second time more than 3 months after initial CVC placement. Dialysis access was established successfully in 38 of 39 (97%) implementations of the IOA procedure. Median intervention time was 43 minutes. No complications occurred.
Limitations:
No comparison to other methods to place CVCs and the observational study design.
Conclusions:
The IOA approach is a promising method to enable rapid access to the right jugular vein in the setting of pre-existing TCVO. Additional experience is needed to understand the generalizability of these observations.
More Related Videos
Related Concept Videos
01:24Hemodialysis II: Procedure and Complications
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:25Hemodialysis I: Introduction
01:29Venous Thrombosis III: Interprofessional Care
01:21Cardiac Catheterization II: Right Heart Catheterization
01:24Cardiac Catheterization III: Left Heart Catheterization