Abstract:
Introduction: Central venous catheterisation (CVC) is essential for haemodialysis in end-stage kidney disease, but superior vena cava (SVC) stenosis or occlusion often complicates long-term access. The azygos vein, a collateral drainage pathway, has been rarely used intentionally for catheterisation.
Case description: We report on a 68-year-old male on haemodialysis with SVC perforation and stenosis due to prolonged catheter use. After a failed guidewire-assisted exchange, a non-tunnelled CVC was successfully placed in the enlarged azygos vein under fluoroscopy. The patient continued haemodialysis without complications, and the two-month follow-up confirmed catheter patency.
Conclusion: This case demonstrates the azygos vein as a viable alternative for haemodialysis access in SVC stenosis.
Learning points: Complications related to vascular access creation remain one of the main reasons for morbidity and mortality in patients on chronic haemodialysis.Prevalence of the stenosis of the superior vena cava is increasing among dialysis-dependent patients, so new pathway such as the azygos vein presents potentially viable alternative for vascular access.
Reference:Pushevski V, Janusevski F, Janevski Z, Dejanov P. The Azygos Vein as an Alternative Route for Haemodialysis Catheterisation. Eur J Case Rep Intern Med. 2025 May 20;12(6):005441. doi: 10.12890/2025_005441. PMID: 40502956; PMCID: PMC12151558.