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

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.

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.

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