Thoracoscopic‐Assisted Placement of Azygos Vein Central Venous Catheter in a Child

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. This case illustrates the use of thoracoscopic‐assisted central access in a child requiring chronic hemodialysis with limited venous sites due to thrombosis of central vessels.