Endovascular Central Venous Stenosis Treatment Ended With Superior Vena Cava Perforation, Pericardial Tamponade, and Exitus

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.

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Endovascular retrieval of two migrated stents from pulmonary artery by means of balloon catheter

American Journal of Interventional Radiology ◽

10.25259/ajir_28_2021 ◽

2021 ◽

Vol 5 ◽

pp. 21

Author(s):

Saad Saeed Alqahtani ◽

Ahmed Kandeel Elhadad ◽

Rusha Abdulmohsen Sarhan ◽

Saleh Mohamed Alwaleedi

Keyword(s):

Pulmonary Artery ◽

Superior Vena ◽

Balloon Catheter ◽

Vena Cava ◽

Brachiocephalic Vein ◽

Central Venous ◽

Venous Stenting ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

The Right

Long-term central venous catheters can be associated with central venous stenosis in up to 50% of cases. Central venous stenosis can be managed with central venous stenting which was demonstrated to restore patency and improve suboptimal results after percutaneous transluminal angioplasty. Dislodgment of venous stents into the right side of the heart or the pulmonary artery during stent deployment is one of the most feared complications of this procedure. Percutaneous removal of these migrated stents is the preferred alternative for the more invasive operative intervention, which may be very hazardous in these patients. We report an unusual case of a 52-year-old man on hemodialysis who underwent endovascular stenting to treat a tight stenosis of the right brachiocephalic vein and superior vena cava and suffered from stent migration to the left pulmonary artery, requiring removal by interventional radiologist.

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Central Venous Stenosis after Hemodialysis: Case Reports and Relationships to Catheters and Cardiac Implantable Devices

Cardiorenal Medicine ◽

10.1159/000496065 ◽

2019 ◽

Vol 9 (3) ◽

pp. 135-144 ◽

Cited By ~ 1

Author(s):

Mario Pacilio ◽

Silvio Borrelli ◽

Giuseppe Conte ◽

Roberto Minutolo ◽

Antonino Musumeci ◽

...

Keyword(s):

Case Reports ◽

Superior Vena ◽

Sinus Node ◽

Vena Cava ◽

Venous Catheter ◽

Transluminal Angioplasty ◽

Central Venous ◽

Central Venous Stenosis ◽

Cardiac Devices ◽

Venous Stenosis

The appropriate vascular access for hemodialysis in patients with cardiac implantable electronic devices (CIED) is undefined. We describe two cases of end-stage renal disease patients with CIED and tunneled central venous catheter (CVC) who developed venous cava stenosis: (1) a 70-year-old man with sinus node disease and pacemaker in 2013, CVC, and a Brescia-Cimino forearm fistula in 2015; (2) a 75-year-old woman with previous ventricular arrhythmia with implanted defibrillator in 2014 and CVC in 2016. In either case, after about 1 year from CVC insertion, patients developed superior vena cava (SVC) syndrome due to stenosis diagnosed by axial computerized tomography. In case 1, the patient was not treated by angioplasty of SVC and removed CVC with partial resolving of symptoms. In case 2, a percutaneous transluminal angioplasty with placement of a new CVC was required. To analyze these reports in the context of available literature, we systematically reviewed studies that have analyzed the presence of central venous stenosis associated with the simultaneous presence of CIED and CVC. Five studies were found; two indicated an increased incidence of central venous stenosis, while three did not find any association. While more studies are definitely needed, we suggest that these patients may benefit from epicardial cardiac devices and the insertion of devices directly into the ventriculus. If the new devices are unavailable or contraindicated, peritoneal dialysis or intensive conservative treatment in older patients may be proposed as alternative options.

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Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

Journal of Endovascular Therapy ◽

10.1177/1526602821989330 ◽

2021 ◽

pp. 152660282198933

Author(s):

Pablo V. Uceda ◽

Julio Peralta Rodriguez ◽

Hernán Vela ◽

Adelina Lozano Miranda ◽

Luis Vega Salvatierra ◽

...

Keyword(s):

Superior Vena Cava ◽

Esophageal Varices ◽

Superior Vena ◽

Vena Cava ◽

Central Venous Catheters ◽

Dialysis Patients ◽

Central Venous ◽

Endovascular Recanalization ◽

Flow Through ◽

The Right

The health care system in Peru treats 15,000 dialysis patients annually. Approximately 45% of patients receive therapy using catheters. The incidence of catheter-induced superior vena cava (SVC) occlusion is increasing along with its associated significant morbidity and vascular access dysfunction. One of the unusual manifestations of this complication is bleeding “downhill” esophageal varices caused by reversal of blood flow through esophageal veins around the obstruction to the right atrium. Herein is presented the case of an 18-year-old woman on hemodialysis complicated by SVC occlusion and bleeding esophageal varices who underwent successful endovascular recanalization of the SVC. Bleeding from “downhill” esophageal varices should be considered in the differential diagnosis of dialysis patients exposed to central venous catheters. Aggressive endovascular treatment of SVC occlusion is recommended to preserve upper extremity access function and prevent bleeding from this complication.

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Case of an Incidental Finding of a Persistent Left Superior Vena Cava Discovered After Placement of Central Venous Catheter

CHEST Journal ◽

10.1378/chest.1704971 ◽

2013 ◽

Vol 144 (4) ◽

pp. 292A

Author(s):

Brendon Colaco ◽

Saba Saleem ◽

Clinton Colaco ◽

Mohammad Siddiqui

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Incidental Finding ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Central Venous ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena

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Electrosurgical Removal of a Central Venous Catheter Inadvertently Sutured Into the Superior Vena Cava

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2021.07.036 ◽

2021 ◽

Author(s):

Sandeep Arunothayaraj ◽

Kristoffer Tanseco ◽

Anna-Lucia Koerling ◽

Andrew Hill ◽

Jonathon Hyde ◽

...

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Central Venous

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Persistent Left Superior Vena Cava in Pediatric Patients

The Journal of Vascular Access ◽

10.1177/112972980901000317 ◽

2009 ◽

Vol 10 (3) ◽

pp. 219-220 ◽

Cited By ~ 3

Author(s):

Marco Caruselli ◽

Gianmarco Piattellini ◽

Gianfranco Camilletti ◽

Roberto Giretti ◽

Raffaella Pagni

Keyword(s):

Superior Vena Cava ◽

Pediatric Patients ◽

Central Venous Catheterization ◽

Jugular Vein ◽

Superior Vena ◽

Vena Cava ◽

Central Venous ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena ◽

Venous Catheterization

A persistent left superior vena cava (PLSVC) is a congenital anomaly of the systemic venous system. This anomaly is often discovered as an incidental result during central venous catheterization passing through the left subclavian or the left internal jugular vein. We report two cases of PLSVC in pediatric patients.

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