title: Thoracoscopic-assisted central line placement for a thrombosed superior vena cava.
abstract: BACKGROUND
  In children who require prolonged and multiple venous catheterizations, the superior vena cava and iliofemoral veins may become occluded, making central venous access a difficult challenge. We report an innovative technique of catheter insertion percutaneously from the neck into the right atrium traversing a thrombosed superior vena cava using video-assisted thoracoscopic surgery.
  
  
  METHODS
  Two children with irreversible intestinal failure had 4 central venous accesses insertions using the above-mentioned technique. Both had occluded major central veins after multiple catheterizations. An interventional radiologist and cardiologist failed to establish a central venous access in both patients.
  
  
  RESULTS
  A 9-year-old boy has a long-term catheter functioning for 8 months, and in an 18-month-old girl, the line was removed accidentally 6 weeks from its insertion and 2 months later for a line leak. It was then reinserted each time using the same technique.
  
  
  CONCLUSIONS
  This technique of catheter placement into the right atrium using video-assisted thoracoscopic surgery when other conduits are unavailable can be lifesaving in children depending on total parenteral nutrition.
authors.affiliation: King Saud University, College of Medicine, Riyadh 11671, Saudi Arabia. qahtani@yahoo.com
authors.forename: Aayed R
authors.initials: AR
authors.lastname: Alqahtani
mesh_terms: D002405:Catheterization, Central Venous; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000150:complications / Q000473:pathology*; D008297:Male; D010289:Parenteral Nutrition, Total; D013479:Superior Vena Cava Syndrome / Q000150:complications*; D020775:Thoracic Surgery, Video-Assisted