Thromboembolic Disease Involving the Superior Vena Cava and Brachiocephalic Veinsa

Otten, Todd R.; Stein, Paul D.; Patel, Kalpesh C.; Mustafa, Syed Farrukh; Silbergleit, Allen

doi:10.1378/chest.123.3.809

Cited by 86 publications

(54 citation statements)

References 22 publications

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“…5 The most frequent causes are venous catheter placement and malignancy. A study performed by Otten et al 6 found that 3 patients of 9 with isolated brachiocephalic vein occlusion had no history of central lines but did have extremity AV shunts for dialysis, similar to that in our patient. None of the patients in their study revealed any central nervous system symptoms.…”

Section: Discussionsupporting

confidence: 87%

Upper Extremity Arteriovenous Dialysis Fistula Resulting in Cavernous Sinus Arterialized Blood Flow

Watson¹,

Russo²

2007

American Journal of Neuroradiology

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SUMMARY:Arterialized blood flow in the cavernous sinus may result from carotid-cavernous fistula or dural venous fistula. We encountered an unusual case of arterialized blood flow in the cavernous sinus on MR angiography resulting from arterialized retrograde venous flow in the internal jugular vein. This abnormal flow originated from an upper extremity dialysis arteriovenous fistula in the presence of central venous occlusion. The patient's symptoms of visual disturbance resolved after the central venous occlusion was treated with stent placement.A 36-year-old woman with a history of end stage renal disease, dialysis dependence, and left-arm arteriovenous (AV) fistula was hospitalized with vague abdominal pain and possible bowel obstruction. After 7 days in the hospital, she reported blurriness of vision and eventually provided a history of intermittent visual blurriness and headaches during the past few weeks, as well as mild left-arm pain.Noncontrast MR imaging of the head revealed prominence of the left superior ophthalmic vein and mild left proptosis. Intracranial time-of-flight MR angiography (MRA) was also performed (Fig 1A). This showed abnormally increased signal intensity within the left cavernous sinus, the left transverse sinus, the left inferior petrosal sinus, and the ipsilateral superior ophthalmic vein. This signal intensity was interpreted as suggestive of carotid cavernous sinus fistula or dural venous fistula, and a catheter angiogram was recommended. A conventional cerebral angiogram was then performed. There was no evidence of carotid-cavernous fistula (CCF) (Fig 1B). Injection of the bilateral internal carotid, selective bilateral external carotid, and bilateral vertebral arteries all showed no evidence of dural venous fistula. Contrast injection of the aortic arch revealed normal great vessels, but the late arterial phase showed early flow into the left subclavian vein, as expected with AV fistula. Venous phase images showed that the left brachiocephalic vein was occluded and virtually the entire early left-sided venous contrast return flowed in a retrograde fashion through the left internal jugular vein (Fig 1C). Therefore, the arterialized intracranial venous flow was attributable to retrograde flow in the left jugular vein system.Recanalization of the left innominate vein and placement of a 12 ϫ 40 mm Wallstent (Boston Scientific, Natick, Mass) was then performed. Following recanalization, normal antegrade flow returned to the left jugular vein. Follow-up MR imaging was performed 5 months after recanalization (Fig 2). The study showed resolution of the abnormal signal intensity within the left cavernous sinus, petrosal sinus, and superior ophthalmic vein. There was some residual abnormal signal intensity present within the left transverse sinus, believed to represent persistent arterialized flow or partial thrombus formation. At the time of the follow-up scan, the patient's visual symptoms had resolved.

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Section: Discussionsupporting

confidence: 87%

Upper Extremity Arteriovenous Dialysis Fistula Resulting in Cavernous Sinus Arterialized Blood Flow

Watson¹,

Russo²

2007

American Journal of Neuroradiology

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“…The occurrence of upper extremity deep vein thrombosis prior to any cardiac device implantation is often associated with malignancy and/or central venous lines. In a study on patients with superior vena cava (SVC) and brachiocephalic vein thrombosis, 74 % had cancer [4,19]. Furthermore, Linhart et al identified a trend toward higher obstruction rates in patients with a history of prior pacemaker implantation [5].…”

Section: Risk Factors and Predictors For Venous Obstructionmentioning

confidence: 99%

“…sion [4,19]. Although clinically apparent pulmonary embolism is less frequent in upper-than in lower-extremity deep vein thrombosis, patient outcome after three months does not differ significantly between both groups, making upper-extremity deep vein thrombosis a relevant, clinically under-recognized entity [1].…”

Section: Vessels 1033mentioning

confidence: 99%

Venous Obstruction in Asymptomatic Patients Undergoing First Implantation or Revision of a Cardiac Pacemaker or Implantable Cardioverter-Defibrillator: A Retrospective Single Center Analysis

Pieper

Weis

Fimmers

et al. 2015

Fortschr Röntgenstr

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Venograms were used to determine the presence of venous obstruction. Interrelations between the incidence of venous obstruction and patient-or devicerelated parameters were identified using Fisher's exact test and univariate logistic regression. Multivariate logistic regression was used to identify independent predictors of venous obstruction. Results: 456 patients met the inclusion criteria (330 males, 126 females, 67.8 ± 12.9 years). 100 patients underwent first implantation, and 356 patients underwent device revision (mean time since implantation 82.5 ± 75.3 months). Venous obstruction was present in 11.0 % and 30.1 % before implantation and revision, respectively. Only presence of ventricular escape rhythm was significantly related to venous occlusion (p < 0.001) prior to first implantation. Prior to revision, significant predictors were male sex (p = 0.01), time since implantation (p < 0.0001), presence of escape rhythm (p = 0.02), compromised coagulation (p = 0.02), phenprocoumon (p = 0.005), and peripheral arterial disease (p = 0.01). Conclusion: Although several risk factors could be identified, reliable prediction of venous obstruction was not possible. Therefore, we advocate performing venography in all patients prior to device revision or upgrade to avoid complications. In cases of first device implantation, the risks associated with venography should be weighed against the surprisingly high rate of deep upper vein obstruction.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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“…Most of the cases are due to the oppression of SVC by tumor (3), while the pure intravascular thrombosis is extremely uncommon and only 0.04% of hospitalized adults were diagnosed as cancerrelated SVC thrombosis (4). This report clarifies the rare case of SVC syndrome by cancer-related thrombosis; the underlying cause was quite difficult to diagnose.…”

Section: Introductionmentioning

confidence: 77%

Superior Vena Cava Syndrome Caused by an Intravascular Thrombosis Due to Underlying Prostate Carcinoma

Takeda¹,

Saitoh²,

Takeda³

2008

Intern. Med.

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Thromboembolic Disease Involving the Superior Vena Cava and Brachiocephalic Veinsa

Cited by 86 publications

References 22 publications

Upper Extremity Arteriovenous Dialysis Fistula Resulting in Cavernous Sinus Arterialized Blood Flow

Upper Extremity Arteriovenous Dialysis Fistula Resulting in Cavernous Sinus Arterialized Blood Flow

Venous Obstruction in Asymptomatic Patients Undergoing First Implantation or Revision of a Cardiac Pacemaker or Implantable Cardioverter-Defibrillator: A Retrospective Single Center Analysis

Superior Vena Cava Syndrome Caused by an Intravascular Thrombosis Due to Underlying Prostate Carcinoma

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