Hemopericardium After Superior Vena Cava Stenting for Malignant SVC Obstruction: The Importance of Contrast-Enhanced CT in the Assessment of Postprocedural Collapse

Brant, Jonathan; Peebles, Charles; Kalra, Paul R.; Odurny, A.

doi:10.1007/s002700001795

Cited by 26 publications

(18 citation statements)

References 9 publications

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“…Venous catheterization failure precluded any insertion and deployment of the stent. Furthermore, any risky attempt would have favoured life-threatening guidewire venous perforation, which could lead to hemomediastinum/hemopericardium, particularly in postradiation cancer patients with a fragile SVC wall (7). Therefore, an efficient and attractive approach for this procedure is to catheterize the lumen of the venous implanted catheter as the Ariadne's thread.…”

Section: Discussionmentioning

confidence: 99%

Superior vena cava syndrome: do not miss the ariadne's thread

Hajjam

Marcy²,

Thariat³

et al. 2012

Diagn Interv Radiol

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A central venous catheter tip located too high into the superior vena cava (SVC) is known to be a strong risk factor for central venous thrombosis and subsequent SVC syndrome. We report herein the usefulness of catheterizing the implanted port catheter lumen as a salvage procedure to circumvent a complete SVC occlusion in a breast cancer patient. Because the standard central vein catheterization attempt is often unsuccessful, the port catheter should always be considered as the Ariadne's thread and used as an attempt for catheterization. Central venous catheter tip location assessment is mandatory during the implantation procedure. It is well accepted that the optimal position of the catheter tip is located at the atrial caval junction (1). Importantly, a catheter tip located too high into the superior vena cava (SVC), where it faces the azygos vein arch or upstream into the SVC or one of its tributaries (e.g., brachiocephalic veins [BCVs]), is known to be a strong risk factor for thrombosis and subsequent SVC occlusion (28.8% left, 5% right), especially in cancer patients (2-4). Case reportA 55-year-old female patient with breast cancer presenting with a right internal jugular vein implanted chamber catheter was referred to the emergency department due to severe SVC syndrome. Upon computed tomography (CT) scan examination, the SVC syndrome was found to be due to catheter-related SVC occlusion.The patient was given full anticoagulant therapy, diuretics, and corticoids for one week, and then scheduled to receive an endovascular stent (Fig. 1). The procedure was performed under intravenous sedation (hydroxyzine, 40 mg), analgesia (paracetamol, 1 g), antibiotic prophylaxis (amoxicillin and clavulanic acid, 1 g), and heparin 3000 IU bolus.Using right common femoral vein access, a 5F multi-purpose SVC catheter was used to abut the SVC occlusion, but the retrograde catheterization procedure failed despite the use of an 80 cm long 6F introducer sheath tutor and various hydrophilic guidewires. We then explanted the subclavicular port chamber under sterile conditions while maintaining the 7F internal jugular vein catheter for use as the "Ariadne's thread". The catheter lumen was catheterized using a 260 cm long, 0.025 inch hydrophilic guidewire. The catheter tip was clearly distinguishable despite the complete SVC occlusion, and we were able to easily circumvent the obstruction and target the inferior vena cava. The long femoral sheath was removed and replaced by a short 6F introducer. The 0.025 inch guidewire was pushed downward to the right femoral vein and snared through the right groin introducer sheath using a snare loop. Thus, an internal jugular vein-to-femoral through and through wire access procedure was performed. The 80 cm sheath was reintroduced into the right groin. Right BCV contrast medium opacification showed hypertrophic venous collaterals and no antegrade flow into the SVC. An over-through and through femoro-jugular 260 mm long 0.035 inch exchange Rosen guidewire procedure allowed for a success...

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Section: Discussionmentioning

confidence: 99%

Superior vena cava syndrome: do not miss the ariadne's thread

Hajjam

Marcy²,

Thariat³

et al. 2012

Diagn Interv Radiol

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“…There are several reports about iatrogenic SVC injury (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). The etiologies were SVC stenting (2-5), balloon dila-2…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, only a few cases of iatrogenic SVC perforation have been reported (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). According to recent research (10) of 10 cases, four patients died of SVC perforation, two underwent a stent graft placement, two required pericardial drainage tube, and the remaining two had open surgical repair via median sternotomy.…”

Section: Introductionmentioning

confidence: 99%

Successful Detachable Coil Embolization of Iatrogenic Superior Vena Cava Penetration by Central Venous Catheter: A Case Report

Park

Kim

et al. 2017

Iran J Radiol

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Iatrogenic injuries of the superior vena cava (SVC) are infrequent but could bring severe complications. Perforation of the SVC may result in massive hemorrhage and hemodynamic instability. We report the case of a 58-year-old female with a right hemothorax after left subclavian central venous catheter (CVC) placement. Penetration of the SVC can be managed by coil embolization through left subclavian CVC. As a result, this injury was successfully managed. To our knowledge, this is the first report of management of SVC penetration using coil embolization.

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“…6 A total of 16 cases of SVC perforation and hemopericardium have been described in the literature. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The majority of ruptures became clinically apparent near the time of stenting-seven intraprocedurally, six within 1 hour of the procedure, and one more within 24 hours. However, fatal ruptures caused by strut erosion into the pericardium have been reported at 3 and 6 months postprocedure.…”

Section: Svc Rupture and Cardiac Tamponade As A Complication Of Stentingmentioning

confidence: 99%

“…38 This procedure can also offer definitive therapy; 3 of the 16 reported cases of SVC rupture with cardiac tamponade required no further therapy after pericardiocentesis. 10,11,13 If ultrasound is unavailable and the patient demonstrates strong evidence of cardiac tamponade, a blind pericardiocentesis utilizing a subxiphoid approach can be considered, although it is associated with higher complication rates than ultrasound-guided pericardiocentesis. 39 With this approach, the sheath needle is placed in the angle between the xiphisternum and the left costal margin and advanced toward the left shoulder.…”

Section: Treatment Of Rupture and Tamponadementioning

confidence: 99%

Superior Vena Cava Rupture and Cardiac Tamponade Complicating the Endovascular Treatment of Malignant Superior Vena Cava Syndrome: A Case Report and Literature Review

Stevens

Butty

Johnson

2015

Semin intervent Radiol

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A 47-year-old man with known metastatic small cell lung cancer presented with 1 week of right arm swelling, facial flushing, shortness of breath, right hand weakness, and intermittent blurry vision. Physical examination revealed right upper extremity edema and facial plethora. Computed tomography (CT) of the chest confirmed enlargement of a right upper lobe mass causing near-complete occlusion of the right brachiocephalic vein and superior vena cava (SVC) (►Fig. 1), consistent with SVC syndrome (SVCS). After extensive discussion regarding the risks and benefits of the procedure, the patient elected to proceed with endovascular reconstruction of the central veins.Bilateral basilic vein access was obtained, and digital upper extremity venography confirmed near-complete occlusion of the SVC (►Fig. 2). The occlusion was traversed using a 0.035-inch wire and a 5F catheter, and intraluminal crossing was confirmed with contrast injection. Throughand-through access was obtained via the right common femoral vein, and the SVC and brachiocephalic veins were dilated using 8-and 10-mm balloons (►Fig. 3). Venogram immediately following the 10-mm angioplasty demonstrated contrast extravasation into the mediastinum and likely the pericardial space, indicative of SVC rupture (►Fig. 4). Ultrasound revealed a thin pericardial effusion, which, given the patient's history of radiation, was deemed sufficient to cause tamponade. Overlapping 13 mm Â 5 cm Viabahn-covered stents (Gore Medical, Flagstaff, AZ) were placed from the central aspect of the left brachiocephalic vein to the atriocaval junction (►Fig. 5). However, the patient rapidly decompensated, and despite aggressive resuscitation following advanced cardiac life support (ACLS) protocol, including pericardiocentesis, the patient expired on the table.

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Hemopericardium After Superior Vena Cava Stenting for Malignant SVC Obstruction: The Importance of Contrast-Enhanced CT in the Assessment of Postprocedural Collapse

Cited by 26 publications

References 9 publications

Superior vena cava syndrome: do not miss the ariadne's thread

Superior vena cava syndrome: do not miss the ariadne's thread

Successful Detachable Coil Embolization of Iatrogenic Superior Vena Cava Penetration by Central Venous Catheter: A Case Report

Superior Vena Cava Rupture and Cardiac Tamponade Complicating the Endovascular Treatment of Malignant Superior Vena Cava Syndrome: A Case Report and Literature Review

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