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

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.

Central venous catheters in the left-sided superior vena cava: Clinical implications

2013 ◽  
Vol 48 (2) ◽  
pp. 400-403 ◽  
Author(s):  
Mohammad Bader ◽  
Peter Bromley ◽  
Ingo Jester ◽  
James Bennett ◽  
G. Suren Arul
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Clinical Implications ◽  
Central Venous

Placement of Permanent Central Venous Catheters in Thrombosis of the Superior Vena Cava

2014 ◽  
Vol 26 (1) ◽  
pp. 33-36
Author(s):  
Marina Cornacchiari ◽  
Roberto Ferraresi ◽  
Barbara Gidaro ◽  
Antonia Stasi ◽  
Maria Giuseppina Ponticelli ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Central Venous

Placement of Central Venous Catheters in Patients Undergoing Major Maxillofacial Surgery - A Retrospective Clinical Audit

2010 ◽  
Vol 11 (2) ◽  
pp. 128-131
Author(s):  
Vasileios Zochios ◽  
Michael Gilhooly ◽  
Simon Fenner
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Central Venous Access ◽  
Maxillofacial Surgery ◽  
Vena Cava ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Central Venous

Purpose The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40° to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40° to the superior vena cava wall. Methods Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long. Results 82% of the catheter tips were located above the carina while 61% were angulated at greater than 40°; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards. Conclusions 89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.

scholarly journals Hematemesis, a Rare Presentation for Downhill Esophageal Varices

2021 ◽  
pp. 359-364
Author(s):  
Jeremy Van ◽  
Shubha Singh
Keyword(s):  
Blood Flow ◽  
Esophageal Varices ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Disease Process ◽  
Rare Presentation ◽  
Retrograde Blood Flow ◽  
Flow Through ◽  
The Right

Downhill esophageal varices (DEV) are a rare form of esophageal varices associated with superior vena cava obstruction. Obstruction leads to retrograde blood flow through collateral venous channels, including the esophageal venous plexus, to redirect blood flow to the right atrium via the inferior vena cava. This leads to the formation of DEV. It is a rare phenomenon to have gastrointestinal bleeding, especially hematemesis, on a patient’s first presentation with this disease process. We describe such a case here involving a patient with DEV secondary to metastatic renal cell carcinoma presenting with hematemesis.

scholarly journals Dilated Coronary Sinus: An Indicator of Persistent Left Superior Vena Cava

2020 ◽  
Vol 3 (2) ◽  
pp. 116-117
Author(s):  
Otero D ◽  
Stoddard M ◽  
Ikram S
Keyword(s):  
Superior Vena Cava ◽  
Coronary Sinus ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Flow Through ◽  
The Right ◽  
Dilated Coronary Sinus ◽  
Axis View

An 88-year-old male presented for a routine transthoracic echocardiogram. Dilated coronary sinus was noted, raising the suspicion for persistent left superior venous cava (PLSVC). An agitated saline study from the left upper extremity demonstrated a flow through the coronary sinus into the right ventricle in a parasternal long-axis view. A venogram from the right internal jugular vein showed the PLSVC drained into a much dilated coronary sinus (CS) that connected to the right atrium. The right superior vena cava was absent. PLSVC along with absent right superior vena cava is rare and the inadvertent CS cannulation may result in vessel perforation.

scholarly journals Superior Vena Cava Obstruction Secondary to Prolonged Calcium Therapy: A Benign Etiology, Managed by Vein Graft Bypass Surgery

2020 ◽  
pp. 1-3
Author(s):  
Ahsan Iqbal Cheema ◽  
Ahsan Iqbal Cheema ◽  
Chaudhry Aqeel ◽  
Gari Khan ◽  
Yousif Alqahtani ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Bypass Surgery ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Line ◽  
Superior Vena Cava Obstruction ◽  
Central Venous ◽  
Endovascular Recanalization ◽  
Vena Cava Syndrome

We like to report this case of a 28-year-old lady, who had celiac disease and developed complete Superior Vena Cava Obstruction secondary to prolonged corrective calcium therapy for refractory Hypocalcemia through the central venous line. Usually Superior Vena Cava Syndrome (SVCS) due to Superior Vena Cava obstruction (SVCO) has infective and malignant etiologies. Our case is a rare and benign cause, managed surgically after failed endovascular recanalization by the interventional radiologist.

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