title: Thoracoscopic-assisted placement of azygos vein central venous catheter in a child.
abstract: Loss of central venous access in intestinal failure patients is a potentially fatal complication, and an indication for intestinal transplantation. Thrombosis of the superior vena cava (SVC) has historically been considered a contraindication to small bowel transplantation; however, unconventional central venous access can facilitate survival and eventual transplant procedure in patients with end-stage central venous access. We describe a technique for azygos vein central catheter insertion utilizing thoracoscopic guidance in a 14-year-old girl with thrombosis of the SVC and chronic idiopathic pseudo-obstruction syndrome awaiting multivisceral transplantation. The technique is simplified by utilizing carbon dioxide (CO(2)) insufflation of the thoracic cavity to collapse the lung instead of double-lumen endotracheal tube placement, and no postoperative chest tube drainage of the pleural space is required. Thoracoscopic-assisted central access can also be used in children requiring chronic hemodialysis with limited venous sites due to thrombosis or small size of vessels.
authors.affiliation: Division of Pediatric Surgery, Holtz Children's Hospital, University of Miami/Jackson Memorial Medical Center, Miami, FL, USA. jsola@med.miami.edu
authors.forename: J E
authors.initials: JE
authors.lastname: Sola
authors.forename: W R
authors.initials: WR
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D001401:Azygos Vein / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D006801:Humans; D013906:Thoracoscopy / Q000379:methods*; D014683:Vena Cava, Superior / Q000601:surgery*; D020246:Venous Thrombosis / Q000601:surgery*