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 (CO2) 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.
Original language | English (US) |
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Pages (from-to) | 715-718 |
Number of pages | 4 |
Journal | American Journal of Transplantation |
Volume | 8 |
Issue number | 3 |
DOIs | |
State | Published - Mar 2008 |
Keywords
- Intestinal pseudo-obstruction
- Parenteral nutrition
- Pediatric small intestine transplantation
- Pediatric surgery
- Thoracic surgery
- Vascular access
ASJC Scopus subject areas
- Immunology