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Video-assisted minithoracotomy for right atrial hemodialysis catheter placement after vascular access exhaustion: Two case reports
Gutenberg C Navarro-Zambrano, Jorge W Pozo-Obando, Rommel O Espinoza de los Monteros-Duche, Washington X Osorio-Chuquitarco, Jorge W Huertas-Garzón, Amaury León-Sosa, Henry G Cabezas-Tapia, Isabel Echevarría-Frutos
Gutenberg C Navarro-Zambrano, Jorge W Pozo-Obando, Rommel O Espinoza de los Monteros-Duche, Department of Cardiothoracic Surgery, Hospital de Especialidades de las Fuerzas Armadas No. 1, Quito 170136, Pichincha, Ecuador
Gutenberg C Navarro-Zambrano, Amaury León-Sosa, Isabel Echevarría-Frutos, Faculty of Medicine, Universidad Israel, Quito 170516, Pichincha, Ecuador
Washington X Osorio-Chuquitarco, Jorge W Huertas-Garzón, Department of Nephrology, Hospital de Especialidades de las Fuerzas Armadas No. 1, Quito 170515, Pichincha, Ecuador
Amaury León-Sosa, Department of Intensive Care Unit, Hospital de Especialidades de las Fuerzas Armadas No. 1, Universidad Israel, Quito 170136, Pichincha, Ecuador
Henry G Cabezas-Tapia, Department of Medical Imaging, Hospital de Especialidades de las Fuerzas Armadas No. 1, Quito 170136, Pichincha, Ecuador
Isabel Echevarría-Frutos, Department of Neurosurgery, Hospital de Especialidades de las Fuerzas Armadas No. 1, Universidad Israel, Quito 170136, Pichincha, Ecuador
Author contributions: Navarro-Zambrano GC, Pozo-Obando JW, Espinoza de los Monteros-Duche RO, Osorio-Chuquitarco WX, Huertas-Garzón JW, León-Sosa A, Cabezas-Tapia HG, and Echevarría-Frutos I designed the study; Navarro-Zambrano GC, Pozo-Obando JW and Espinoza de los Monteros-Duche RO performed the surgical procedures; Osorio-Chuquitarco WX and Huertas-Garzón JW managed the nephrology and hemodialysis follow-up; León-Sosa A and Cabezas-Tapia HG contributed to intensive care and imaging support; Echevarría-Frutos I assisted with data collection and manuscript preparation; Navarro-Zambrano GC wrote the first draft of the manuscript; and all authors have read and approved the final manuscript.
AI contribution statement: Some AI-based tools are only used to assist with language revision, grammar correction and translation during the manuscript writing process. This manuscript was written by the authors. All scientific content, including research concepts, methods, results and interpretations, was independently completed by the research team. This tool is only used for language support purposes, such as improving grammar, clarity and translation. It is not used for independent scientific writing or original data analysis. All aspects such as research design, clinical analysis and interpretation of research results were independently completed by the authors. All charts, tables and visual materials were directly created by the authors based on the original clinical data. We confirm that the authors are fully responsible for the scientific content, originality and final version of the submitted manuscript.
Informed consent statement: Written informed consent was obtained from both patients for publication of this case report and accompanying images/videos.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Gutenberg C Navarro-Zambrano, MD, Consultant, Department of Cardiothoracic Surgery, Hospital de Especialidades de las Fuerzas Armadas No. 1, Av. Gran Colombia y Queseras del Medio, Quito 170136, Pichincha, Ecuador.
guten-doc@hotmail.com
Received: December 23, 2025
Revised: February 10, 2026
Accepted: March 10, 2026
Published online: June 25, 2026
Processing time: 174 Days and 17.4 Hours
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
Video-assisted minithoracotomy is a safe, effective salvage approach for right atrial hemodialysis catheter placement in patients with exhausted vascular access.
Core Tip: Patients with end-stage renal disease and complete exhaustion of conventional vascular access represent a major therapeutic challenge. This report of two cases highlights video-assisted right minithoracotomy as a minimally invasive salvage strategy for direct right atrial hemodialysis catheter placement, providing durable access and satisfactory mid-term outcomes in highly complex patients when performed in specialized centers.
