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Case Reports
. 2025 Jun 2;21(1):63-67.
doi: 10.14797/mdcvj.1602. eCollection 2025.

Surfacer Inside-Out Central Venous Catheterization Through an Occluded Inferior Vena Cava

Rishik Puppala  1   2 , Pallavi Gorantla  3 , Bright Benfor  4 , Eric Peden  4
Affiliations
Case Reports

Surfacer Inside-Out Central Venous Catheterization Through an Occluded Inferior Vena Cava

Rishik Puppala et al. Methodist Debakey Cardiovasc J. .

Abstract

This case describes the use of the Surfacer® Inside-Out Access Catheter System (SIO) from Merit Medical in an occluded inferior vena cava. The procedure typically utilizes right femoral vein access with contraindications of acute iliocaval thrombosis due to possible embolization. After history and imaging studies, the occlusion was determined to be chronic in this case, and a decision was made to employ the SIO procedure using an indwelling catheter. This case demonstrates the use of the SIO procedure in certain settings in patients with central venous occlusions who have exhausted all other options.

Keywords: TCVO; central venous catheter; central venous occlusion; inside-out; surfacer.

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Conflict of interest statement

Dr. Peden was a consultant for Merit Medical and a principle investigator in the Investigational Device Trial for FDA approval of the Surfacer Device. He also is currently a consultant for Venostent, Voyager, and Humacyte Inc. All fees are retained by Houston Methodist Hospital. Rishik Puppala, Pallavi Gorantla, and Bright Benfor have no conflicts to disclose.

Figures

CTA demonstrates a type 3 thoracic central venous obstruction
Figure 1
Computerized tomographic angiography demonstrating a type 3 thoracic central venous obstruction.
Angiogram shows retrohepatic occluded IVC repaired with balloon angioplasty with RA access via left femoral venous catheter
Figure 2
Intraoperative fluoroscopy images. (A) Angiogram demonstrated an uncrossable retrohepatic inferior vena cava occlusion. (B) Wire access was obtained into the right atrium via the left femoral venous catheter. (C) Balloon angioplasty of the inferior vena cava was then performed, (D) and a second wire advanced into the right atrium from the right groin.
Fluoroscopy images show successful delivery of surfacer device after retrohepatic IVC recanalization
Figure 3
Fluoroscopy images showing (A) successful delivery of the surfacer device after recanalization of the retrohepatic inferior vena cava. (B) The tip of the tunneled dialysis catheter was then successfully placed in the right atrium.
See this image and copyright information in PMC

References

    1. Gallieni M, Matoussevitch V, Steinke T, 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(10):1654-1660.e1. doi: 10.1016/j.jvir.2020.06.020 - DOI - PubMed
    1. Razavi MK. Overview of the safety and efficacy of the Surfacer® Inside-Out® Access Catheter System for obtaining central venous access in patients with thoracic central venous obstructions. Expert Rev Med Devices. 2020. Sep;17(9):937-944. doi: 10.1080/17434440.2020.1825938 - DOI - PubMed
    1. Razavi MK, Peden EK, Sorial E, 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(1):141-146. doi: 10.1177/1129729820937121 - DOI - PMC - PubMed
    1. Galas N, Shahverdyan R. Use of the Surfacer® Inside-Out® Catheter Access System to Obtain Central Venous Access in Dialysis Patients With Thoracic Venous Obstructions: Single-Center Series. Vasc Endovascular Surg. 2021. Apr;55(3):228-233. doi: 10.1177/1538574420980604 - DOI - PubMed
    1. Tian TQ, Yun YH, Sheng TJ, Yip TT, Tieng Chek EC. Use of Surfacer, an inside-out device, in tandem with HeRO graft for creation of vascular access: Case report of three patients with 18-months follow up. J Vasc Access. 2023. Jul;24(4):813-817. doi: 10.1177/11297298211041434 - DOI - PubMed

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