Video-assisted minithoracotomy for right atrial hemodialysis catheter placement after vascular access exhaustion: Two case reports.

Abstract

Background: End-stage renal disease (ESRD) continues to increase worldwide, and long-term hemodialysis requires reliable vascular access. Progressive exhaustion of peripheral and central venous routes poses a major therapeutic challenge and may necessitate unconventional surgical strategies.

Case summary: We report two patients with ESRD and complete depletion of conventional vascular access who underwent direct right atrial hemodialysis catheter placement via video-assisted thoracoscopic minithoracotomy. The first patient was a 68-year-old man with extensive central venous thrombosis and multiple failed catheterizations. The second was a 32-year-old woman with lupus-related ESRD, recurrent catheter infections, and previous thoracic surgeries. In both cases, intra-atrial catheter placement was successfully achieved under direct thoracoscopic visualization. Both patients experienced uneventful postoperative courses, immediate catheter functionality, and sustained hemodialysis efficacy during an eight-month follow-up period.

Conclusion: Video-assisted minithoracotomy is a safe, effective salvage approach for right atrial hemodialysis catheter placement in patients with exhausted vascular access.