Direct azygos vein and superior vena cava cannulation for parenteral nutrition

As a result of superior vena cava thrombosis and ligation of the inferior vena cava, central venous access was limited in a patient with large, recurrent, intestinal fistulas. Transthoracic catheterization of the azygos vein provided a successful route for parenteral nutrition for 9 wk on one occasion, and transthoracic catheterization of the superior vena cava allowed parenteral nutrition for over 9 months on another.