title: The second and third right posterior intercostal veins: an alternate route for central venous access with an implantable port in children.
abstract: OBJECTIVE
  Some children dependent on total parenteral nutrition for long periods have no more axillary, internal jugular, external jugular, saphenous, and femoral veins available for cannulation. In such patients, the central venous system can still be accessed via the azygos vein by placing an implantable port catheter through one of the right posterior intercostal veins. This is the first known description of such procedure.
  
  
  METHODS
  We report the use of the second and third right intercostal veins for placement of the catheter by right intrapleural thoracotomy in 2 pediatric patients with short gut syndrome.
  
  
  RESULTS
  Recovery from the thoracotomy was uncomplicated, and the patients could receive complete intravenous nutritive mixtures immediately after the insertion of the catheter. Both patients remain dependent on total parenteral nutrition and are awaiting an intestinal transplantation.
  
  
  CONCLUSIONS
  The knowledge of alternate routes to obtain central venous access for prolonged parenteral nutrition is critically important, and the azygos system can be used when more accessible veins are unavailable.
authors.affiliation: Pediatric Surgery Division and Liver Transplantation Unit, University of São Paulo Medical School, São Paulo-SP, CEP: 01246-903, Brazil. uenist@usp.br
authors.forename: Uenis
authors.initials: U
authors.lastname: Tannuri
authors.forename: Ana Cristina Aoun
authors.initials: AC
authors.lastname: Tannuri
authors.forename: João Gilberto
authors.initials: JG
authors.lastname: Maksoud
mesh_terms: D001401:Azygos Vein; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods; D012778:Short Bowel Syndrome; D013908:Thoracotomy