Thoracoscopic transpleural azygos vein cannulation as vascular access for hemodialysis: experimental study in a porcine model.

Temporary hemodialysis is conventionally performed by accessing either the jugular, the femoral, or the subclavian veins. Repetitive or chronic use of these venous sites may lead to complications such as thrombosis of the superior vena cava. Alternative venous accesses have been described. The purpose of this acute experiment is to evaluate in 8 female pigs the feasibility and immediate complications associated with the transpleural cannulation of the azygos vein performed under thoracoscopy. All animals survived the experiment. There were 5 successful cannulations. There was one termination of the procedure and 2 conversions to thoracotomy because of bleeding which, even if minor, hindered the view of the operation field. There was one lung injury caused by a retractor. In conclusion, the thoracoscopic technique was found to be feasible and could become an alternative access in patients with unsuitable conventional central venous access. Further investigation could validate our findings.