Endovascular Reconstruction of Type 3 Central Venous Obstruction: A Case Report
Superior vena cava (SVC) syndrome with central thoracic vein occlusion associated with the use of intravascular devices, such as a catheter for dialysis, is increasing and involves younger patients. In dialytic patients it is imperative to preserve venous access, particularly for whom who will rely on dialysis for an extended duration; endovascular venous reconstruction is the recommended treatment but there are not standardized guidelines about the type of stent and technique. In our complex case, for the central vein occlusion, a mixed double barrel and Y approach technique was adopted using bare-metal stent (16 × 80 mm Sinus XL-Flex, Seda) and covered stent (VBX, Gore), to achieve a good clinical result. Superior vena cava (SVC) syndrome with central thoracic vein occlusion associated with the use of intravascular devices is increasing and involves younger patients. Hemodialysis patients are at higher risk for central vein occlusion and symptomatic SVC syndrome. It is imperative to preserve venous access, particularly for younger patients who will rely on dialysis for an extended duration. Endovascular venous reconstruction is the recommended treatment but there are not standardized guidelines about the type of stent and technique. In the present case report the primary objective was to resolve the central vein occlusion and maintain vein patency through double barrel and Y technique together, employing bare metal and covered stents.Highlights
Abstract
Preprocedural venography depicting upper limbs deep vein thrombosis due to occlusion of BCT confluence. (a) Left BCT occlusion with evidence of collaterals; (b) right BCT occlusion around the CVC with collaterals. BCT, brachiocephalic trunk; CVC, central venous catheter.
(a) Stent (open-cell Nitinol stent) deployment in the left BCT. (b) Kissing-balloon technique used after the deployment of the right VBX stent to dilate both stents up to 8 mm. (c) Second VBX stent deployment inside the bare-metal stent in the left BCT. (d) Final check with a self-expandable open-cell Nitinol stent (16 × 80 mm Sinus XL-Flex, Seda) from left subclavian vein to proximal SVC and two balloon-expandable covered stents (VBX, Gore) at the BCTs junction, the right one passing through bare-metal stent struts. BCT, brachiocephalic trunk; SVC, superior vena cava.
Maximum intensity projection (MIP) (a) and volume rendering reconstruction (b) of the angio-CT after 6 months depicting correct stents position and complete patencyof the treated vessels. Angio-CT = angio-computed tomography.
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