The existing Berenstein catheter in the right internal jugular vein from right common femoral vein access was exchanged for the 8 French AngioJet™ ZelanteDVT catheter. Rheolytic thrombectomy has since been widely adapted for percutaneous coronary intervention (PCI) and treatment for lower extremity deep vein thrombosis (Antoniucci et al. However, superior vena cava syndrome can present acutely in the setting of vena cava thrombosis. In addition, there was high-grade narrowing at the cavoatrial junction secondary to extrinsic compression from the known right upper lobe pulmonary mass. When a patient presents with acute SVC syndrome and has critical symptoms such as airway compromise, interventional radiologists are frequently consulted for management. AngioJet™ thrombectomy is another tool available to interventional radiologists when a patient’s clinical condition necessitates treatment. The patient was intubated and interventional radiology was consulted. The right brachiocephalic vein courses medial and inferior to the dome of the right lung pleura. Outpatient endobronchial ultrasound biopsy records became available which demonstrated squamous cell carcinoma for the tumor adjacent to the right main bronchus. However, the long term results following stent placement are unknown and rethrombosis rates can be significant.
2016). Batra S, Doval DC, Batra U, Suresh P, Dhiman A, Talwar V. Hepatobiliary Pancreat Dis Int. Antoniucci D, Valenti R, Migliorini A et al (2004) Comparison of rheolytic thrombectomy before direct infarct artery stenting versus direct stenting alone in patients undergoing percutaneous coronary intervention for acute myocardial infarction. MK reviewed clinical documents such as H&P and consult notes. Surgery may consist of the removal of the upper lobe of a lung together with its associated structures (subclavian artery, vein, branches of the brachial plexus, ribs and vertebral bodies), as well as mediastinal lymphadenectomy. Based on the combination of changes in mentation, facial swelling and lip edema, the patient was given a score of 4 on the Kishi scoring system for superior vena cava syndrome.
Part of HHS The largest case series available in the literature for malignant SVC syndrome showed approximately 79% clinical patency with CDT and stent placement over an average 7 month follow up (Kee et al. 2015; Leung et al. 111(1):31–37, CAS Gallbladder cancer with tumor thrombus in the superior vena cava. The heparin infusion was continued post procedurally.
Our experience with AngioJet™ demonstrates its applicability for SVC syndrome with short term technical and clinical success. Please enable it to take advantage of the complete set of features! A CT scan of the chest demonstrated a massive thrombosis of both brachiocephalic veins and the SVC. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Am J Cardiol 93(8):1033–1035, Article
Due to the completely thrombosed right internal jugular vein, ultrasound guided access of the right basilic vein using Seldinger technique was obtained and an 8 French vascular sheath was placed. On the subsequent morning, the patient’s son noticed the skin changes and facial swelling. Its position and close proximity to vital structures (such as nerves and spine) may make surgery difficult. 2018). Anastomosis at the vena cava predisposed the patient to acute stenosis at the vena cava.
With our patient, we chose to perform AngioJet™ (Boston Scientific, Marlborough, MA) rheolytic thrombectomy in conjunction with kissing stents to alleviate acute venous congestion and decrease thrombotic burden that could become pulmonary emboli (Ptohis et al.
When the brachial plexus roots are involved, it will produce Pancoast syndrome; involvement of sympathetic fibers as they exit the cord at T1 and ascend to the superior cervical ganglion will produce Horner's syndrome. SpringerPlus. A second, 12 mm × 4 cm uncovered stent was advanced over the right basilic vein Amplatz wire. Patient’s clinical appearance after being intubated. The signed consent was uploaded to the institution’s electronic medical record and is available upon request.
2015). Epub 2017 Dec 26. COVID-19 is an emerging, rapidly evolving situation. The compression extended to the origin of the innominate vein. Radiol Case Rep 10(1):991, Seligson MT, Surowiec SM (2019) Superior Vena Cava Syndrome. Amit Ramjit. The stents were subsequently dilated using a 14 mm × 6 cm angioplasty balloon. Diagnosis of Pancoast tumor is usually made after evaluating clinical symptoms and imaging.
Emerg Med Clin North Am. Interventional radiology was consulted for endovascular management of SVC syndrome. 1974). Filling defects were seen in the innominate veins with multiple venous collateral vessels, suggestive of SVC syndrome. This allows rapid dubulking of thrombus to prevent iatrogenic pulmonary emboli. |
The patient was treated with rheolytic thrombectomy for approximately 47 s and 10 mm balloon angioplasty. Due to the extensive thrombus burden and pre-existing pulmonary compromise, the decision was made to perform pharmacothrombolysis prior to establishing outflow. Correspondence to J Med Vasc. The patient began vomiting multiple times and had a possible brief syncopal episode while vomiting and lacerated the bridge of her nose on the commode. USA.gov. The patient was transitioned to apixaban and discharged on hospital day 10. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 1998). 2010). CVIR Endovascular Catheter directed thrombolysis has high clinical success and long-term patency. PubMed Google Scholar. Salmi R(1), Gaudenzi P, Di Todaro F, Morandi P, Nielsen I, Manfredini R. Small perforations can occur which can be managed with prolonged balloon inflation. In superior vena cava syndrome, obstruction of the superior vena cava by a tumor (mass effect) causes facial swelling cyanosis and dilatation of the veins of the head and neck.