Surgical Removal of Endovascular Stent after Migration to the Right Ventricle Following Right Subclavian Vein Deployment for Treatment of Central Venous Stenosis

Central venous stenosis or occlusion occurs in 11-50% of hemodialysis patients with prior subclavian vein cannulation and ipsilateral fistula or shunt. In these cases, endovascular intervention, including ballooning and stenting, is a feasible strategy for selected patents. We report an unusual case of a 60-year-old man on hemodialysis who underwent endovascular stenting for right brachiocephalic vein stenosis and experienced stent migration to the right atrium, requiring surgical treatment.

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Percutaneous transluminal angioplasty for central venous stenosis or occlusion in hemodialysis patients

The Journal of Vascular Access ◽

10.1177/1129729817747545 ◽

2018 ◽

Vol 20 (1_suppl) ◽

pp. 87-92 ◽

Cited By ~ 4

Author(s):

Yuki Horita

Keyword(s):

Percutaneous Transluminal Angioplasty ◽

Interventional Therapy ◽

Transluminal Angioplasty ◽

Radial Force ◽

Brachiocephalic Vein ◽

Central Venous ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

The Right ◽

Percutaneous Transluminal

The objectives of central venous percutaneous transluminal angioplasty are to dilate the venous lesion and to extend the life of arteriovenous fistula for hemodialysis. It is reasonable to perform percutaneous transluminal angioplasty for central venous lesions if this interventional therapy is required to maintain stable dialysis therapy. However, the presence of large fresh thrombus at central venous lesion site represents a contraindication to percutaneous transluminal angioplasty unless the thrombus can first be removed by thrombectomy. Balloon angioplasty is a basic treatment for central venous lesion, but stent implantation is sometimes required. The self-expandable or balloon-expandable stent is chosen by the lesion location and characteristics. The lesion in subclavian vein is generally treated by self-expandable stent and right brachiocephalic vein is treated by balloon-expandable stent. The organic lesion of innominate vein with plaque is treated by self-expandable stent. Note that the innominate venous stenosis is sometimes caused by compression between the right brachiocephalic artery and the sternum, and this lesion is treated by balloon-expandable stent because the radial force of balloon-expandable stent is stronger than self-expandable stent. It is important to understand the indication and stent selection for central venous percutaneous transluminal angioplasty.

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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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Surgical removal of a foreshortened right innominate vein Wallstent causing venous outflow obstruction

Vascular ◽

10.1177/17085381211068996 ◽

2022 ◽

pp. 170853812110689

Author(s):

Kristin Schafer ◽

Eric Goldschmidt ◽

Andrew Seiwert

Keyword(s):

Upper Extremity ◽

Venous Hypertension ◽

Complete Relief ◽

Surgical Removal ◽

Central Venous ◽

Outflow Obstruction ◽

Venous Outflow ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

Venous Outflow Obstruction

Objectives: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. Methods: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. Results: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient’s symptoms. Conclusion: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy.

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Failure to place a tunneled hemodialysis catheter due to malformation of right internal jugular vein draining to subclavian vein

Journal of International Medical Research ◽

10.1177/0300060518766649 ◽

2018 ◽

Vol 46 (6) ◽

pp. 2481-2485

Author(s):

Li-na Zhu ◽

Li-jun Mou ◽

Ying-Hu ◽

Gui-na Wei ◽

Jun-feng Sun

Keyword(s):

Internal Jugular Vein ◽

Subclavian Vein ◽

Jugular Vein ◽

Central Venous ◽

Hemodialysis Catheter ◽

Central Venous Stenosis ◽

Inferior Segment ◽

History Of ◽

The Right ◽

Computed Tomography Venography

The right internal jugular vein (IJV) is an important access site for hemodialysis catheterization. Venous cannulation failure is usually caused by central venous stenosis and is rarely related to vessel malformation. We herein present a case of failure to place a tunneled hemodialysis catheter into the right IJV. The patient had an arteriovenous fistula in the right arm with inadequate flow and a history of multiple central venous catheterizations. The guidewire was repeatedly misplaced into the right subclavian vein (SV) regardless of the technique used. Computed tomography venography revealed that the inferior segment of the right IJV drained into the ipsilateral SV. To the best of our knowledge, this is the first report of catheterization failure due to abnormal drainage of the right IJV into the ipsilateral SV.

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Right Ventricle Mass Removal from Tricuspid Valve Apparatus: An Unusual Thromboembolic Complication of Severe Ketoacidosis

The Heart Surgery Forum ◽

10.1532/hsf.1378 ◽

2016 ◽

Vol 19 (2) ◽

pp. 077

Author(s):

Ireneusz Haponiuk ◽

Maciej Chojnicki ◽

Konrad Paczkowski ◽

Wojciech Kosiak ◽

Radosław Jaworski ◽

...

Keyword(s):

Right Ventricle ◽

Tricuspid Valve ◽

Mild Hypothermia ◽

Heart Function ◽

Thromboembolic Complication ◽

Surgical Removal ◽

Unusual Complication ◽

Type I ◽

Definitive Therapy ◽

The Right

The presence of a pathologic mass in the right ventricle (RV) may lead to hemodynamic consequences and to a life-threatening incident of pulmonary embolism. The diagnosis of an unstable thrombus in the right heart chamber usually necessitates intensive treatment to dissolve or remove the pathology. We present a report of an unusual complication of severe ketoacidosis: thrombus in the right ventricle, removed from the tricuspid valve (TV) apparatus. A four-year-old boy was diagnosed with diabetes mellitus (DM) type I de novo. During hospitalization, a 13.9 × 8.4 mm tumor in the RV was found in a routine cardiac ultrasound. The patient was referred for surgical removal of the floating lesion from the RV. The procedure was performed via midline sternotomy with extracorporeal circulation (ECC) and mild hypothermia. Control echocardiography showed complete tumor excision with normal atrioventricular valves and heart function. Surgical removal of the thrombus from the tricuspid valve apparatus was effective, safe, and a definitive therapy for thromboembolic complication of pediatric severe ketoacidosis.<br /><br />

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