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The Azygos Vein as an Alternative Route for Haemodialysis Catheterisation

Vladimir Pushevski1, Filip Janusevski2, Zoran Janevski1

  • 1University Clinic of Nephrology, Medical Faculty, SS Cyril and Methodius University, Skopje, Republic of North Macedonia.

European Journal of Case Reports in Internal Medicine
|June 12, 2025
PubMed

Insights

The azygos vein offers a viable alternative for central venous catheterisation in patients with superior vena cava stenosis, a common complication in long-term haemodialysis access.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Central venous catheterisation (CVC) is crucial for haemodialysis in end-stage kidney disease.
  • Superior vena cava (SVC) stenosis or occlusion frequently complicates long-term CVC access.
  • The azygos vein is an underutilized collateral pathway for venous access.

Purpose of the Study:

  • To report a case of successful CVC placement in the azygos vein for haemodialysis access.
  • To highlight the azygos vein as a potential alternative in cases of SVC stenosis.

Main Methods:

  • A 68-year-old male on haemodialysis with SVC perforation and stenosis underwent CVC placement.
  • A non-tunnelled CVC was successfully inserted into the enlarged azygos vein under fluoroscopic guidance after failed guidewire exchange.
  • The patient's haemodialysis was continued without complications.

Main Results:

  • Successful CVC placement in the azygos vein was achieved.
  • The patient maintained haemodialysis without complications for two months.
  • Catheter patency was confirmed at the two-month follow-up.

Conclusions:

  • The azygos vein can serve as a feasible alternative vascular access pathway for haemodialysis.
  • This approach is particularly relevant for patients with superior vena cava stenosis.
  • Addressing complications of vascular access is critical for reducing morbidity and mortality in haemodialysis patients.
Abstract

Keywords:
Vascular access creationazygos veinsuperior vena cava stenosis

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