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

Purpose: 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). Materials and methods: 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. Results: 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/cm 2 . Trend toward longer procedure time was noted for Type 3–4 obstructions and collateral snare use. Conclusion: 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.