An alternative to inside-out access for central venous catheter placement in thoracic central vein obstruction

To evaluate feasibility, technical success, and safety of a fluoroscopy-guided percutaneous technique for central venous catheter (CVC) placement in patients with thoracic central venous obstruction (TCVO).

We retrospectively included 16 adult and pediatric patients with TCVO requiring CVC placement. Technical success was defined as successful venous access and catheter placement; clinical success as functional catheter use without failure. Safety was assessed using CIRSE classification. Procedural metrics were recorded. Descriptive statistics (median, IQR; counts, %) were used. Exploratory comparisons between obstruction type (Type 1-2B vs 3-4) and procedural metrics were performed using Mann-Whitney U test.

Seventeen procedures were performed in 16 patients (median age 27.5 years, range 7-61; 11 males). Access and catheter placement succeeded in 16/17 procedures (94.1%) and all patients (100%). In one case, first attempt failed and a second successful procedure was requested. First-attempt per-patient technical success was 93.7%. Clinical success was 100%. No major complications occurred; minor adverse events (CIRSE grade 1) were observed in three patients (18.7%). Median procedure time 52 min, fluoroscopy 12 min and 5 s, contrast 46 mL, and DAP 91.3 Gy/cm². Trend toward longer procedure time was noted for Type 3-4 obstructions and collateral snare use.

Fluoroscopy-guided percutaneous CVC placement is feasible and safe in TCVO using the described technique and may represent a widely applicable alternative to dedicated inside-out system.