{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T21:09:29Z","timestamp":1788815369604,"version":"build-2803163510"},"reference-count":13,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T00:00:00Z","timestamp":1780790400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Vasc Access"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods:<\/jats:title>\n                    <jats:p>\n                      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\u20132B vs 3\u20134) and procedural metrics were performed using Mann\u2013Whitney\n                      <jats:italic toggle=\"yes\">U<\/jats:italic>\n                      test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Seventeen procedures were performed in 16 patients (median age 27.5\u2009years, range 7\u201361; 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\u2009min, fluoroscopy 12\u2009min and 5\u2009s, contrast 46\u2009mL, and DAP 91.3\u2009Gy\/cm\n                      <jats:sup>2<\/jats:sup>\n                      . Trend toward longer procedure time was noted for Type 3\u20134 obstructions and collateral snare use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298261455247","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:18:51Z","timestamp":1780892331000},"page":"2357-2365","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["An alternative to inside-out access for central venous catheter placement in thoracic central vein obstruction"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4160-8018","authenticated-orcid":false,"given":"Anna Maria","family":"Ierardi","sequence":"first","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Milan, Italy"},{"name":"Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy"},{"name":"Unit of Diagnostic Imaging and Stereotactic Radiosurgery, CDI Centro Diagnostico Italiano S.p.A., Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Biondetti","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Velio","family":"Ascenti","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore Alessio","family":"Angileri","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluca","family":"Torcia","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Lanza","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Milan, Italy"},{"name":"Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy"},{"name":"Unit of Diagnostic Imaging and Stereotactic Radiosurgery, CDI Centro Diagnostico Italiano S.p.A., Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Papa","sequence":"additional","affiliation":[{"name":"Unit of Diagnostic Imaging and Stereotactic Radiosurgery, CDI Centro Diagnostico Italiano S.p.A., Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpaolo","family":"Carrafiello","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Milan, Italy"},{"name":"Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,7]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2017.12.013"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2015.01.014"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.2024166"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2005.00762.x"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.01.024"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2016.11.008"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2016.12.1207"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2020.06.020"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-025-04200-w"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1129729819867547"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/1538574420980604"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvscit.2022.10.019"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1148\/rg.240178"}],"container-title":["The 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