Haemodialysis requires maintenance of a functioning access to the bloodstream. In patients with exhaustion of vascular access, this may pose significant challenges, and alternative last-resort sites for placement of central venous catheters might be needed. We report a case of vascular access exhaustion, with several anomalies of central venous drainage and failure of multiple arteriovenous accesses. This patient was proposed for an unconventional trans-atrial catheter placement via sternotomy with an intrathoracic graft. The catheter was successfully used for over 18 months, which reinforces that this can be a viable approach when other methods have failed.
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