Endovascular stenting for the management of port-a-cath associated superior vena cava syndrome

Hodgkin Lymphoma-Associated Superior Vena Cava Syndrome: A Case Report and Review of the Literature

Patient: Male, 53-year-old

Final Diagnosis: Hodgkin lymphoma • superior vena cava syndrome

Symptoms: Dry cough • dyspnea • facial edema • fatigue

Medication: —

Clinical Procedure: —

Specialty: Hematology • Oncology

Case study of an oncological emergency: Superior Vena Cava Syndrome (SVCS)

Superior vena cava syndrome (SVCS) is an oncological emergency. It is expected that the incidence of SVCS may rise with the increase in usage of central lines for both oncological and non-oncological reasons. The authors of this article present a case study in which a 56-year-old female patient presented at the emergency department with a three-week history of facial swelling, significant hearing loss, unrelenting cough, hoarseness, and swelling of the arms, chest and upper back. A CT scan demonstrated total occlusion of the superior vena cava, confirming SVCS. In this case report, the authors present a discussion of the causes of SVCS, its clinical presentation in relation to this patient's history, and the intervention provided to this patient.

[Not Available]

Le syndrome de la veine cave supérieure (SVCS) représente une urgence oncologique. L’utilisation croissante des cathéters centraux pour des raisons oncologiques et non oncologiques pourrait faire augmenter l’incidence de ce syndrome. Dans cet article, les auteurs présentent une étude de cas portant sur une femme de 56 ans qui s’est présentée aux urgences pour un gonflement du visage perdurant depuis trois semaines et accompagné d’une perte d’audition importante, d’une toux continuelle, d’un enrouement et d’une enflure des bras, du thorax et du haut du dos. Un tomodensitogramme a révélé une occlusion complète de la veine cave supérieure, ce qui a confirmé le diagnostic de SVCS. La présente étude de cas discute des causes du SVCS, expose le tableau clinique liée aux antécédents de la patiente, et décrit l’intervention effectuée auprès de la patiente.

Thoracoscopic-Assisted Ventriculo-Azygous Shunt Placement for the Treatment of Hydrocephalus

BACKGROUND

Cerebrospinal fluid diversion is one of the most frequent neurosurgical procedures across the world and can be challenging in select patients who fail standard distal drainage sites.

OBJECTIVE

To present the case of a woman after failing peritoneal, pleural, and atrial distal drainage sites who underwent a thoracoscopic-assisted ventriculo-azygous vein shunt placement.

METHODS

A 32-year-old woman presented to our hospital with long-standing history of hydrocephalus and shunt dependence. She had failed peritoneal and atrial shunts secondary to infection, scarring, and clot formation. At presentation, she had a pleural shunt in place and developed a large pleural effusion with shortness of breath.

RESULTS

She was taken to the operating room where a thoracoscopic-assisted ventriculo-azygous vein shunt was placed through a mini-thoracotomy. Postoperatively, she has not required a shunt revision in >2 years of follow-up.

CONCLUSION

When other distal sites fail, our case report illustrates a novel surgical technique capable of being performed through a multidisciplinary approach.

Central vein dilatation prior to concomitant port implantation

Implantation of subcutaneous port systems is routinely performed in patients requiring repeated long-term infusion therapy. Ultrasound- and fluoroscopy-guided implantation under local anesthesia is broadly established in interventional radiology and has decreased the rate of complications compared to the surgical approach. In addition, interventional radiology offers the unique possibility of simultaneous management of venous occlusion. We present a technique for recanalization of central venous occlusion and angioplasty combined with port placement in a single intervention which we performed in two patients. Surgical port placement was impossible owing to occlusion of the superior vena cava following placement of a cardiac pacemaker and occlusion of multiple central veins due to paraneoplastic coagulopathy, respectively. In both cases the affected vessel segments were dilated with balloon catheters and the port systems were placed thereafter. After successful dilatation, the venous access was secured with a 25-cm-long, 8-Fr introducer sheath, a subcutaneous pocket prepared, and the port catheter tunneled to the venipuncture site. The port catheter was introduced through the sheath with the proximal end connected to a 5-Fr catheter. This catheter was pulled through the tunnel in order to preserve the tunnel and, at the same time, allow safe removal of the long sheath over the wire. The port system functioned well in both cases. The combination of recanalization and port placement in a single intervention is a straightforward alternative for patients with central venous occlusion that can only be offered by interventional radiology.