Dialysis catheter insertion using Surfacer Inside-Out Access Catheter System in a heart transplant recipient

Central venous occlusion (CVO) is a common complication in hemodialysis patients. The Surfacer Inside-Out Access Catheter System is designed to gain access through previously occluded right-sided central veins. We report a case of a 74-year-old heart transplant recipient with end stage kidney disease and multiple failed dialysis accesses who developed bilateral upper CVO and femoral catheter dependence and underwent right internal jugular re-canalization with Surfacer Inside-Out technology. To our knowledge, this is the first successful tunneled dialysis catheter (TDC) insertion using Surfacer technology in a heart transplant recipient. These patients are at risk of anastomotic stenoses as a complication after cardiac transplantation. This, coupled with the fact that long-term steroid use has been associated with vascular fragility, leads to increased risk of vascular complications in endovascular interventions. But in patients with exhausted vascular access from CVO, insertion of TDC with Surfacer technique is safe and feasible.