Inside-Out Central Venous Catheter placement through an Occluded Stent скачать в хорошем качестве

Inside-Out Central Venous Catheter placement through an Occluded Stent

The novel Surfacer® catheter system (Bluegrass Vascular Technologies, San Antonio, TX) has been designed to facilitate right-sided central venous catheter (CVC) placement through an occluded central venous system after conventional means have failed. Previous reports have documented favorable technical success and low complication rates of this procedure. In this video we demonstrate how to place a CVC through an occluded stent in the right innominate vein, using the Surfacer device, with cone-beam CT angiography (CBCTA) guidance. This case report was approved by the institutional review board of Houston Methodist Research Institute, Houston, TX, and no identifiable patient information is included in the video . The procedure was performed in a hybrid suite (Artis Pheno®, VE10, Siemens Healthineers, Germany) under general anesthesia, with bilateral percutaneous access of the femoral veins: The right access for inserting the device, and the left for contrast injection. A 12-French reinforced sheath was placed through the right groin over an Amplatz wire and the workstation sheath advanced to engage the occluded stent. The device was then inserted up to the tip of the sheath (00:02:23). We then performed a CBCTA to guide the rest of the procedure. We have previously reported the important role of this imaging protocol in enhancing the safety of the procedure 4 . Next, the exit target was placed on the skin at the supraclavicular space, while the device was advanced cephalad through the occlusion and positioned at the superior border of the stent under 2D/3D fusion overlay (00:03:28). The exit target was then aligned with the eyelet of the device and the sharp needle-wire advanced through the stent to the surface of the skin. The externalized wire was then grabbed with a pair of forceps and pulled to establish through-through access (00:04:00). We then advanced a 6 Fr sheath over the wire and brought in a 6 mm balloon over a second wire to dilate the track through the struts of the stent (00:04:39). A 19cm tip-to-cuff Glidepath TDC was then tunneled and inserted according to standard procedure. References 1. Razavi M.K., Peden E.K., Sorial E., Ross J.R., Aruny J.E., Pflederer T.A., et. al.: Efficacy and safety associated with the use of the Surfacer® Inside-Out® Access Catheter System: Results from a prospective, multicenter Food and Drug Administration-approved Investigational Device Exemption study. J Vasc Access 2021 Jan; 22: pp. 141-146. View In ArticleCross Ref 2. Gallieni M., Matoussevitch V., Steinke T., Ebner A., Brunkwall S., Cariati M., et. al.: Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry. J Vasc Interv Radiol 2020 Oct; 31: pp. 1654-1660.e1. View In ArticleCross Ref 3. Reindl-Schwaighofer R., Matoussevitch V., Winnicki W., Kalmykov E., Gilbert J., Matzek W., et. al.: A Novel Inside-out Access Approach for Hemodialysis Catheter Placement in Patients With Thoracic Central Venous Occlusion. Am J Kidney Dis 2020 Apr; 75: pp. 480-487. View In ArticleCross Ref 4. Benfor B., Chinnadurai P., Peden E.K.: Advanced Intraoperative Imaging guidance for Inside-Out Central Venous Recanalization using a novel catheter access system. J Vasc Surg Venous Lymphat Disord 2022 Aug 5; S2213-333X(22)00328-6 _________________________________ A DeBakey CV Education event Presented by Houston Methodist DeBakey Heart & Vascular Center. Building on Dr. Michael E. DeBakey’s commitment to excellence in education, Houston Methodist DeBakey CV Education is an epicenter for cardiovascular academic and clinical educational programs that support the provision of optimal care to patients suffering from cardiovascular conditions and diseases. FOR MORE INFORMATION DeBakey CV Education: https://www.houstonmethodist.org/educ... For the latest education and training opportunities from DeBakey CV Education: http://bit.ly/HMdebakeyemail Follow Us: Facebook:   / debakeycvedu   Twitter:   / debakeycvedu   Livestream: https://livestream.com/debakey SmugMug: https://debakey.smugmug.com/ Want concise, relevant reviews of the hottest topics in CV medicine? Subscribe for FREE to the Methodist DeBakey Cardiovascular Journal for quarterly, peer-reviewed issues delivered to your door. https://journal.houstonmethodist.org/