[Superior vena cava stent implantation: preserving an indwelling port catheter by temporary shift of the brachiocephalic vein]

Endovascular port-a-cath rescue in acute thrombotic superior vena cava syndrome

Acute superior vena cava (SVC) syndrome is managed by endovascular recanalization, venoplasty with stenting, and anticoagulation. It is often associated with central venous catheters. We present a case of a 55-year-old woman with acute SVC syndrome due to port-a-cath-associated thrombosis of the SVC and the brachiocephalic and subclavian veins who was treated with catheter-based thrombectomy and local spray thrombolysis, venoplasty, and stent placement. Port-a-cath restoration was achieved in the same session by endovascular snaring and repositioning. This case demonstrates that reoperation with surgical catheter removal and reinsertion of central venous catheters with possible complications (eg, rethrombosis, bleeding) can be avoided by single-session endovascular management.

Para-Axial Central Venous Stent Placement in Patients with Malignant Central Venous Obstruction with a Venous Port

The authors performed a para-axial central venous stent (p-CVS) placement in 38 patients and implanted the stent without having to remove the functioning port. No difficulties were experienced in catheter function with p-CVS. In-stent stenosis was seen in 6 of 24 patients in the p-CVS group and in 6 of 18 patients in the intrastent venous stent placement group (P = .333). No complications occurred in any patient with p-CVS when the venous port was removed. Thus, p-CVS can be an alternative way to insert a CVS in patients who already have a functioning venous port.

Superior Vena Cava (SVC) Endovascular Reconstruction with Implanted Central Venous Catheter Repositioning for Treatment of Malignant SVC Obstruction

Superior vena cava (SVC) syndrome is a group of clinical signs caused by the obstruction or compression of SVC and characterized by edema of the head, neck, and upper extremities, shortness of breath, and headaches. The syndrome may be caused by benign causes but most of the cases are caused by lung or mediastinal malignant tumors. Stenting of SVC has become widely accepted as the palliative treatment for this condition in malignant diseases, as it offers rapid relief of symptoms and improves the quality of life. Preserving previously placed central venous catheters (CVCs) is a major issue in this population. We report the case of a patient with SVC syndrome caused by tumoral obstruction due to central small-cell lung cancer who had right subclavian implanted CVC and a preferential head and neck venous drainage through the left internal jugular and brachiocephalic vein (BCV). We describe a complex procedure of SVC reconstruction with two different objectives: left recanalization and stent placement to ensure head and neck venous drainage and right BCV stenting for CVC repositioning and subsequent replacement. We also review published cases of SVC obstructions stenting with catheter repositioning. The patient experienced quick relief of symptoms after treatment. Chemotherapy was rapidly delivered through the preserved implanted CVC access. A 3-month follow-up computed tomography showed stents patency.

Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction

PURPOSE

To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction.

MATERIALS AND METHODS

CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance.

RESULTS

All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days).

CONCLUSIONS

Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.

Stenting of the superior vena cava and left brachiocephalic vein with preserving the central venous catheter in situ

Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.