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Liu Y, Wang Y, Wang X, Zhang B, Lu X, Liang X, Wang P. Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access. Sci Rep 2024; 14:12709. [PMID: 38830938 PMCID: PMC11148013 DOI: 10.1038/s41598-024-63287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024] Open
Abstract
To assess the efficacy of stent grafts (SGs) in managing central venous obstruction disease (CVOD) in hemodialysis (HD) patients with arteriovenous (AV) access, and to identify predictive factors influencing the SG treatment outcomes. HD subjects with CVOD who underwent SGs placement at our center between August 2018 and June 2022 were enrolled. Survival curve analysis using the Kaplan-Meier method and log-rank test was performed. Cox proportional hazards regression analysis was employed to identify predictive factors associated with outcomes. A total of 59 SG implantation procedures for CVOD were analyzed, comprising 30 cases of stenosis and 29 cases of occlusion. The access circuit primary patency (ACPP) at 6, 12, and 24 months post-SG placement were 80.9%, 53.8%, and 31.4%, respectively, while, the target lesion primary patency (TLPP) were 91.3%, 67.6%, and 44.5%, respectively. Subgroup analysis revealed higher TLPP in the stenosis group compared to the occlusion group, although the difference was not statistically significant (P = 0.165). The TLPP was significantly improved by SG placement in those who had antecedent balloon dilations (P < 0.001). Cox proportional hazards regression identified target lesion length ≥ 30 mm and procedure defects as independent predictors of lower TLPP after SG treatment for CVOD in HD patients. SG placement demonstrates safety and efficacy in managing CVOD among HD patients, leading to improved TLPP of endovascular therapy (EVT) for CVOD. Notably, long target lesions (≥ 30 mm) and procedure defects emerged as predictive factors influencing TLPP.
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Affiliation(s)
- Yamin Liu
- Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, Henan Province, 450052, People's Republic of China
| | - Yufei Wang
- Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, Henan Province, 450052, People's Republic of China
| | - Xinfang Wang
- Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, Henan Province, 450052, People's Republic of China
| | - Beihao Zhang
- Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, Henan Province, 450052, People's Republic of China
| | - Xiaoqing Lu
- Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, Henan Province, 450052, People's Republic of China
| | - Xianhui Liang
- Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, Henan Province, 450052, People's Republic of China
| | - Pei Wang
- Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, Henan Province, 450052, People's Republic of China.
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2
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Yan A, Ford KS, Faloye AO. Superior Vena Cava Rupture Complicated by Cardiac Tamponade. J Cardiothorac Vasc Anesth 2024; 38:788-791. [PMID: 38184382 DOI: 10.1053/j.jvca.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Amy Yan
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA
| | - Korrin Scott Ford
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA
| | - Abimbola O Faloye
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA.
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3
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Fereydooni A, Sgroi MD. Management of thoracic outlet syndrome in patients with hemodialysis access. Semin Vasc Surg 2024; 37:50-56. [PMID: 38704184 DOI: 10.1053/j.semvascsurg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 05/06/2024]
Abstract
Patients with threatened arteriovenous access are often found to have central venous stenoses at the ipsilateral costoclavicular junction, which may be resistant to endovascular intervention. Stenoses in this location may not resolve unless surgical decompression of thoracic outlet is performed to relieve the extrinsic compression on the subclavian vein. The authors reviewed the management of dialysis patients with central venous lesions at the thoracic outlet, as well as the role of surgical decompression with first-rib resection or claviculectomy for salvage of threatened, ipsilateral dialysis access.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Suite CJ350, MC5639, Palo Alto, CA, 94304
| | - Michael David Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Suite CJ350, MC5639, Palo Alto, CA, 94304.
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Cirillo-Penn NC, Kalra M. A 40-year-old woman with symptomatic superior vena cava syndrome. J Vasc Surg Venous Lymphat Disord 2023; 11:663-664. [PMID: 37080691 DOI: 10.1016/j.jvsv.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 04/22/2023]
Affiliation(s)
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
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SEN I, KALRA M, GLOVICZKI P. Interventions for superior vena cava syndrome. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:674-681. [DOI: 10.23736/s0021-9509.22.12448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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6
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Inoue T, Fujii K, Kaneda T, Kitayama H. Mid-Term Patency of Spiral Saphenous Vein Graft for Malignant Superior Vena Cava Syndrome. Vasc Endovascular Surg 2022; 56:817-819. [PMID: 35961606 DOI: 10.1177/15385744221121205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reports documenting the mid-term patency of spiral saphenous vein grafts for superior vena cava syndrome in patients with advanced thoracic malignancy are, so far, scarce. The present report describes a 69-year-old man who suffered superior vena cava syndrome due to malignant invasion by advanced lung cancer. Since the huge mass in the anterior mediastinum was unresectable, a bypass from the left innominate vein to the right atrium using an autologous spiral saphenous vein graft was surgically created. Postoperatively, the patient received chemoradiotherapy and maintenance anticoagulant therapy, resulting in survival for 4 years without graft occlusion or recurrence of superior vena cava syndrome.
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Affiliation(s)
- Takehiro Inoue
- Department of Cardiovascular Surgery, 145696Mimihara General Hospital, Osaka, Japan
| | - Kosuke Fujii
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Osaka, Japan
| | - Toshio Kaneda
- Department of Cardiovascular Surgery, 145696Mimihara General Hospital, Osaka, Japan
| | - Hitoshi Kitayama
- Department of Cardiovascular Surgery, 145696Mimihara General Hospital, Osaka, Japan
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Cortopassi IO, Gosangi B, Asch D, Bader AS, Gange CP, Rubinowitz AN. Diseases of the pulmonary arteries: imaging appearances and pearls. Clin Imaging 2022; 91:111-125. [DOI: 10.1016/j.clinimag.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
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Rezziki A, El malki H, Boukabous S, Banana Y, Meftah H, Haddiya I, Bentata Y, Moutaouekkil EM, Benzirar A, El Mahi O. Right subclavian artery to right atrium bypass using Polytetrafluoroethylene (PTFE) graft in hemodialysis patient with central venous occlusion: Case report. Ann Med Surg (Lond) 2022; 76:103438. [PMID: 35360505 PMCID: PMC8960889 DOI: 10.1016/j.amsu.2022.103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Case presentation Clinical discussion Conclusion Central venous Occlusion (CVO) is a serious complication which occurs mainly in patients with chronic indwelling central venous catheters for dialysis. We report the case of a patient with end-stage Kidney disease (ESKD), who was admitted for chronic occlusion of the superior and inferior vena cava. So she underwent a right subclavian artery to right atrium (RA) bypass using polytetrafuloroetylene (PTFE) graft. Bypass to RA by mini thoracotomy insision is rarely performed, and remains the last ditch resort to preserve adequate vascular access in hemodialysis patients with central venous occlusion. Fistulas as a first approach for dialysis access must be privileged at the expense of central catheters to prevent CVO.
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Affiliation(s)
- Abdellah Rezziki
- Department of Vascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Hicham El malki
- Department of Cardiovascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Sara Boukabous
- Department of Nephrology – Dialysis and Kidney Transplantation, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Youssef Banana
- Department of Vascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Corresponding author.
| | - Hicham Meftah
- Department of Nephrology – Dialysis and Kidney Transplantation, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Intissar Haddiya
- Department of Nephrology – Dialysis and Kidney Transplantation, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Yassamine Bentata
- Department of Nephrology – Dialysis and Kidney Transplantation, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - El Mehdi Moutaouekkil
- Department of Cardiovascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Adnane Benzirar
- Department of Vascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Omar El Mahi
- Department of Vascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
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Akkakrisee S, Hongsakul K. Venous stent versus conventional stent for the treatment of central vein obstruction in hemodialysis patients: a retrospective study. Acta Radiol 2022; 63:59-66. [PMID: 33779305 DOI: 10.1177/02841851211005163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular treatment is a first-line treatment for upper thoracic central vein obstruction (CVO). Few studies using bare venous stents (BVS) in CVO have been conducted. PURPOSE To evaluate the treatment performance of upper thoracic central vein stenosis between BVS and conventional bare stent (CBS) in hemodialysis patients. METHODS Hemodialysis patients with upper thoracic central vein obstruction who underwent endovascular treatment at the interventional unit of our institution from 1 January 2008 to 31 December 2018 were enrolled in the present study. CBS was used to treat central vein obstruction in 43 patients and BVS in 34 patients. We compared the primary patency rates and complications between the two stent types. P values < 0.05 were considered statistically significant. RESULTS The patient demographic data between the CBS and BVS groups were similar. The characteristics of the lesions, procedures, and complications were not significantly different between the two groups (P > 0.05). There were no statistically significant differences of primary patency rates at three and six months between the BVS and CBS groups (94.1% vs. 86.0% and 73.5% vs. 58.1%, respectively; P > 0.05). The primary patency rate at 12 months in the BVS group was significantly higher than that in the CBS group (61.8% vs. 32.6%; P = 0.008). CONCLUSION Endovascular treatment of central vein obstruction with BVS provided a higher primary patency rate at 12 months than CBS.
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Affiliation(s)
- Surasit Akkakrisee
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Keerati Hongsakul
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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10
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Kordzadeh A, Askari A, Hanif MA, Gadhvi V. Superior Vena Cava Syndrome and Wallstent: A Systematic Review. Ann Vasc Dis 2022; 15:87-93. [PMID: 35860826 PMCID: PMC9257386 DOI: 10.3400/avd.ra.21-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Alan Askari
- Cambridge University Hospitals NHS Foundation Trust
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11
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Dragomir L, Marina V, Anghele M, Anghele AD. Clinical or Imaging Diagnosis of the Current Medical Practice for Superior Vena Cava Syndrome? Diagnostics (Basel) 2021; 11:diagnostics11112058. [PMID: 34829405 PMCID: PMC8623254 DOI: 10.3390/diagnostics11112058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 12/04/2022] Open
Abstract
Most cases of superior vena cava syndrome are easily diagnosed bya clinical examination alone, but several diagnostic tests and procedures can be helpful. When a patient presentswith a suspected diagnosis of superior vena cava syndrome, the first step is to obtain an imaging study that confirms the diagnosis and aids treatment decisions. Magnetic resonance imaging, contrast-enhanced CT scanning, radionuclide flow studies and traditional venography are all appropriate techniques. Still, the CT scan is the most readily available technology in most centers. The CT scan and magnetic resonance imaging also provide information on possible etiologies and can therefore direct the approach towards a tissue diagnosis.
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Affiliation(s)
- Liliana Dragomir
- Clinical-Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800201 Galati, Romania;
| | - Virginia Marina
- Medical Department of Occupational Health, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800201 Galati, Romania
- Correspondence: ; Tel.: +40-770-89-82-74
| | - Mihaela Anghele
- Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800201 Galati, Romania;
| | - Aurelian-Dumitrache Anghele
- Department of General Surgery, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800201 Galati, Romania;
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12
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Magee A, Walsh K, Spence M, McCrossan B. Balloon expandable stent implantation for superior vena caval obstruction following surgical repair of partial anomalous pulmonary venous drainage: Medium term follow-up. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Kagohashi K, Satoh H. Fluoro-deoxyglucose-positron emission tomography/CT scan in superior vena cava syndrome due to radiation-induced fibrosis. Rep Pract Oncol Radiother 2021; 26:451-453. [PMID: 34277099 PMCID: PMC8281899 DOI: 10.5603/rpor.a2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Katsunori Kagohashi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito-city, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito-city, Japan
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14
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Ali H, Sarfraz S, Sarfraz A. Recurrent Hematemesis From Downhill Esophageal Varices: A Therapeutic Challenge for Gastroenterologists. Cureus 2021; 13:e13840. [PMID: 33859896 PMCID: PMC8038912 DOI: 10.7759/cureus.13840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Downhill or upper esophageal varices have an etiology that differs from that of the “uphill” varices secondary to portal hypertension. Approximately 0.1% of all cases of variceal hemorrhage are due to downhill varices. The underlying etiology is obstruction of the superior vena cava (SVC) which results in the shunting of blood from the systemic circulation into the esophageal plexus, predominantly the upper two-thirds. The management should be directed to relieve the vascular obstruction. One of the causes of SVC obstruction leading to downhill variceal bleeding is dialysis catheter-associated SVC stenosis. We report the case of a 34-year-old male with hematemesis associated with downhill varices due to chronic SVC obstruction because of a central venous catheter.
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Affiliation(s)
- Hassam Ali
- Internal Medicine, East Carolina University, Vidant Medical Center, Greenville, USA
| | - Shiza Sarfraz
- Anesthesiology, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Bahawalpur, PAK
| | - Abeera Sarfraz
- Internal Medicine, Federal Medical and Dental College, Islamabad, PAK
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15
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Maksimov AV, Gaĭsina ÉA, Feĭskhanov AK. [Complications of permanent vascular access for haemodialysis]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:165-174. [PMID: 35050263 DOI: 10.33529/angio2021411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Permanent vascular access is the basis of renal replacement therapy by the method of programmed haemodialysis, on whose stable functioning depends the life of patients with end-stage renal disease. At the present time, there is significant deficit of scientific and methodological Russian-language literature on this problem, with no Russian consensus documents concerned. This article is a review of the contemporary world literature dedicated to the problem of permanent vascular access, including currently in force European (2018) and North American (2019) guidelines for good clinical practice, also discussing the problems of strategy and tactics of creating a permanent vascular access, monitoring its dysfunction, pathophysiology of functioning of arteriovenous fistulas. Presented herein are unified approaches to diagnosis and treatment of thrombolytic and haemorrhagic complications associated with the access, as well as local infectious and non-infectious complications. Special attention is paid to indications for the operation and rational therapeutic decision-making.
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Affiliation(s)
- A V Maksimov
- Department of Vascular Surgery, Republican Clinical Hospital of the Ministry of Public Health of the Republic of Tatarstan, Kazan, Russia; Kazan State Medical Academy - Branch of the Russian Medical Academy of Continuous Professional Education under the RF Ministry of Public Health, Kazan, Russia
| | - É A Gaĭsina
- Department of Vascular Surgery, Republican Clinical Hospital of the Ministry of Public Health of the Republic of Tatarstan, Kazan, Russia
| | - A K Feĭskhanov
- Department of Vascular Surgery, Republican Clinical Hospital of the Ministry of Public Health of the Republic of Tatarstan, Kazan, Russia
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Li X, D'Amico G, Quintini C, Uso TD, Gadani S, Romero-Marrero C, Martin C, Partovi S. Intravascular ultrasound in the diagnosis and treatment of central venous diseases. VASA 2020; 50:2-10. [PMID: 33138741 DOI: 10.1024/0301-1526/a000914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Intravascular ultrasound (IVUS) has been used extensively in coronary applications. Its use in venous applications has increased as endovascular therapy has increasingly become the mainstay therapy for central venous diseases. IVUS has been used for both diagnostic and therapeutic purposes in managing venous stenotic disease, venous occlusive disease, and IVC filter placement and removal. IVUS has been proven to be effective in providing detailed measurement of the venous anatomy, which aid in determining the appropriate size and the approach for venous stent placement. In IVC filter placement, IVUS can provide detailed measurement and guide IVC filter placement in emergent and critical care settings. It also has certain utility in filter removal. At any rate, to date there are only a few studies examining its impact on patient outcomes. Prospective randomized controlled trials are warranted in the future.
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Affiliation(s)
- Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Giuseppe D'Amico
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Cristiano Quintini
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Teresa Diago Uso
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Carlos Romero-Marrero
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Martin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
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Eberhardt F, Bunck AC, Codjambopoulo P, Kalmbach K, Stöckigt F. Benign vena cava superior syndrome in patients with cardiac implantable electronic devices: Presentation and management. HeartRhythm Case Rep 2020; 6:549-553. [PMID: 32983865 PMCID: PMC7498635 DOI: 10.1016/j.hrcr.2020.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Frank Eberhardt
- Department of Cardiology, Evangelisches Krankenhaus Kalk, Cologne, Germany
- Address reprint requests and correspondence: PD Dr med Frank Eberhardt, Department of Cardiology, Evangelisches Krankenhaus Kalk, Buchforststr. 2, 51103 Cologne, Germany.
| | - Alexander C. Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Kilian Kalmbach
- Department of Anasthesiology, Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Florian Stöckigt
- Department of Cardiology, Electrophysiology and Rhythmology, Krankenhaus Porz am Rhein, Cologne, Germany
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
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18
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Diathermy-assisted recanalization of chronic superior vena cava obstruction, case report. Radiol Case Rep 2020; 15:1168-1172. [PMID: 32547673 PMCID: PMC7283972 DOI: 10.1016/j.radcr.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 11/15/2022] Open
Abstract
The number of cases of superior vena cava syndrome (SVCS) increased due to increased cardiac devices and central venous catheters. Management of benign SVCS is still controversial. A 51-year-old male known to have ischemic cardiomyopathy and chronic renal failure on regular hemodialysis. In the last 12 months, he had progressive shortness of breath and swelling of his upper part of the body. Examination revealed engorgement of the neck veins, facial puffiness, and pitting edema of both upper limbs. Venography showed occluded SVC. We applied a 50 Watt of energy via electrocautery pen to a Hi-Torque 0.014 Astato guidewire to cross the occluded segment retrogradely. We used 2 stents 39 mm, mounted on BIB 20/40 mm. Final angiography revealed full restoration of SVC flow. Diathermy use to cross a chronic total SVC obstruction is feasible and safe. Endovascular techniques are suitable as initial management of benign SVC syndrome.
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19
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Deshwal H, Ghosh S, Magruder K, Bartholomew JR, Montgomery J, Mehta AC. A review of endovascular stenting for superior vena cava syndrome in fibrosing mediastinitis. Vasc Med 2019; 25:174-183. [PMID: 31804157 DOI: 10.1177/1358863x19884130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Fibrosing mediastinitis (FM) is a rare disorder of inflammation and fibrosis involving the mediastinum. The formation of fibroinflammatory mass in the mediastinum can lead to obstruction of mediastinal structures and cause severe debilitating and life-threatening symptoms. Superior vena cava syndrome (SVCS) is a dreaded complication of FM with no medical therapy proven to be efficacious. Spiral vein grafting has long been utilized as first-line therapy for SVC syndrome due to FM. Endovascular repair with stents and angioplasty for malignant causes of SVC syndrome is well established. However, there are limited data on their utility in SVC syndrome due to FM. We present two cases of SVC syndrome due to FM treated with endovascular stenting and a detailed review of current literature on its utility in SVCS due to benign causes.
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Affiliation(s)
- Himanshu Deshwal
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, NY, USA
| | - Subha Ghosh
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Karen Magruder
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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20
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Abstract
Background The objective of management of superior vena cava syndrome (SVCS) is to promptly alleviate the uncomfortable symptoms. Conventional approaches do not always achieve results as rapidly as endovascular management with stent placement. Objectives To report the experience with endovascular management of SVCS of a Vascular and Endovascular Surgery Service at a Brazilian university hospital. Methods Symptomatic type III SVCS cases were managed with angioplasty and stent placement in 28 patients aged from 37 to 68 years, between 2002 and 2012. The etiology of SVCS was lung or thoracic cancer in 18 patients, while occlusion of the vein for prolonged use of catheters was the cause in the other 10 cases. Results Superior vena cava occlusion repair was not possible in one oligosymptomatic patient with a very severe lesion. Technical success was achieved in 96.4%. There were two deaths, one due to pulmonary embolism, 24 hours after a successful procedure, and the other due to compression of the airways by tumor mass some hours after the procedure. Clinical success was achieved in all cases of technical success, including one patient who died suddenly, after total regression of SVCS symptoms. Symptoms disappeared 24 hours and 48 hours after management in16 and 8 patients respectively; improvement was slower but progressive after 48 hours in the remaining patients. Conclusions Endovascular stent placement was effective for management of SVCS, with good technical and clinical success rates and provided prompt relief from symptoms.
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Affiliation(s)
- Walter Kegham Karakhanian
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | - Walter Zavem Karakhanian
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | - Sergio Quilici Belczak
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
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Gwozdz AM, Silickas J, Smith A, Saha P, Black SA. Endovascular Therapy for Central Venous Thrombosis. Methodist Debakey Cardiovasc J 2018; 14:214-218. [PMID: 30410652 DOI: 10.14797/mdcj-14-3-214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Central vein thrombosis is defined as thrombosis of the major vessels draining either the upper or lower extremities. It presents most commonly in the upper limb, where it affects the subclavian veins and the superior vena cava; in the lower limb, it affects the common iliac veins and the inferior vena cava. These different anatomical segments pose unique challenges in both acute and chronic settings, and this article will summarize the current best practice treatment options.
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22
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Tan GM, Chi KWK, Yan BPY. Mid-term Results of a Novel Dedicated Venous Stent for the Treatment of Chronic Thoracic Central Vein Obstruction of Benign Aetiology. Eur J Vasc Endovasc Surg 2018; 57:417-423. [PMID: 30404722 DOI: 10.1016/j.ejvs.2018.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/06/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Endovascular treatment is indicated for the treatment of symptomatic thoracic central vein obstruction (TCVO) but is limited by high rates of restenosis and the need for re-intervention. The aim was to assess the safety and mid-term patency of a novel dedicated venous stent for the treatment of TCVO of benign aetiology. METHODS This was a prospective single centre observational study of 20 patients (median age 65 years, 50% male) referred for the treatment of symptomatic chronic (>three months duration) TCVO between May 2016 and January 2018. Balloon angioplasty with implantation of a self expanding nitinol stent (Vici, Boston Scientific, Marlborough, MA, USA) was performed in all patients. Clinical records including demographics, aetiologies and types of TCVO, and procedural details were recorded. Patients were followed up clinically at one, six, and 12 months. Primary and assisted primary patency were reported. RESULTS All 20 lesions were total occlusions, of which 55% (n = 11) were de novo, 10% (n = 2) peri-stent restenosis, and 35% (n = 7) in-stent re-occlusion. The aetiology of TCVO was predominantly (95%) because of multiple or prolonged central venous line insertion. The procedural success rate was 90% (18/20) with no procedural complications. The median follow up was 13.5 months. Primary patency was 100% at 6 months. One patient required re-intervention for stent in segment restenosis at 7 months. The assisted primary patency rate was 100% at 12 months. CONCLUSION Endovascular treatment of benign TCVO with the novel dedicated venous stent was safe and effective in relieving obstructive symptoms with excellent one year patency rates.
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Affiliation(s)
- Guang Ming Tan
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ken Wai Kin Chi
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Bryan Ping Yen Yan
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia.
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23
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Is Long-Term Anticoagulation Required after Stent Placement for Benign Superior Vena Cava Syndrome? J Vasc Interv Radiol 2018; 29:1741-1747. [PMID: 30396845 DOI: 10.1016/j.jvir.2018.07.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/15/2018] [Accepted: 07/23/2018] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To identify whether symptom relief and stent patency vary with use of long-term anticoagulation after stent placement for benign superior vena cava (SVC) syndrome. MATERIALS AND METHODS Patients with benign SVC syndrome treated with stent placement between January 1999 and July 2017 were retrospectively identified (n = 58). Average age was 49 years (range, 24-80 y); 34 (58%) were women, and 24 (42%) were men. Average follow-up was 2.4 years (range, 0.1-11.1 y, SD 2.6). Of cases, 37 (64%) were due to a long-term line/pacemaker, and 21 (36%) were due to fibrosing mediastinitis. After stent placement, 36 (62%) patients were placed on long-term anticoagulation, and 22 (38%) were not placed on anticoagulation. Percent stenosis was evaluated on follow-up imaging by dividing smallest diameter of the stent by a normal nonstenotic segment of the stent and multiplying by 100. RESULTS Technical success was achieved in all cases. There was no significant difference in number of patients who reported a return of symptoms characteristic of benign SVC syndrome between the anticoagulated (16 of 36; 44.4%) and nonanticoagulated (11 of 22; 50%) groups (P = .68). There was no significant difference in the mean percent stenosis between the anticoagulated (40.4% ± 34.7% [range, 0-100%]) and nonanticoagulated (32.1% ± 29.2% [range, 1.7%-100%]) groups (P = .36). No significant difference was found in the time (days) between date of procedure and date of return of symptoms (anticoagulated, 735.9 d ± 1,003.1 [range, 23-3,851 d]; nonanticoagulated, 478 d ± 826.6 [range, 28-2,922 d]) (P = .49). There was no difference in primary patency between groups (P = .59). Finally, 1 patient (2.8%) in the anticoagulated group required surgical intervention, whereas none in the nonanticoagulated group required surgical intervention. CONCLUSIONS No significant difference was observed in clinical and treatment outcomes in patients who did and did not receive anticoagulation after stent placement for benign SVC syndrome. Management of benign SVC syndrome after stent placement may not require anticoagulation if confirmed by additional studies.
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Hooker JB, Hawkins BM, Abu-Fadel MS. Endovascular Stenting in 2 Patients with Benign Superior Vena Cava Syndrome. Tex Heart Inst J 2018; 45:264-269. [PMID: 30374243 DOI: 10.14503/thij-17-6263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Superior vena cava syndrome has typically been associated with malignant conditions; however, the number of benign cases has started to grow as the use of upper-extremity venous lines and implantable cardiac devices increases. Whereas endovascular techniques are standardly used to treat patients with malignancies, the optimal care of patients with benign causes is less clear because they typically have longer life expectancies. We describe 2 cases of benign superior vena cava syndrome successfully managed with endovascular stenting, and we review the relevant literature. Of 145 cases in 10 series (average follow-up time, 24 mo), 96% of patients experienced symptomatic relief after endovascular management, with a primary patency rate of 66% and a secondary rate of 93%. Although few data exist to compare open surgical and endovascular techniques directly, both approaches appear to produce similar rates of patency. Both approaches frequently necessitate secondary intervention to maintain patency, but endovascular management is associated with fewer complications. We conclude that endovascular management of benign superior vena cava syndrome is a safe, effective, and reasonable initial management approach.
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Donnelly J, Gabriels J, Galmer A, Willner J, Beldner S, Epstein LM, Patel A. Venous Obstruction in Cardiac Rhythm Device Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:64. [PMID: 29995225 DOI: 10.1007/s11936-018-0664-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW A variety of complex vascular pathologies arise following the implantation of electronic cardiac devices. Pacemaker and defibrillator lead insertion may cause proximal venous obstruction, resulting in symptomatic venous congestion and the compromise of potential future access sites for cardiac rhythm lead management. RECENT FINDINGS Various innovative techniques to recanalize the vein and establish alternate venous access have been pioneered over the past few years. A collaborative team of electrophysiologists and vascular specialists strategically integrate the patient's vascular disease into the planning of electrophysiology procedures. When vascular complications occur after device implantation, the same team effectively manages both the resulting vascular sequelae and related cardiac rhythm device challenges. This review will outline the various vascular challenges related to device therapy and offer an effective strategy for their management.
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Affiliation(s)
- Joseph Donnelly
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA.
| | - James Gabriels
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Andrew Galmer
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Jonathan Willner
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Stuart Beldner
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Laurence M Epstein
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Apoor Patel
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
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26
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Haddad MM, Simmons B, McPhail IR, Kalra M, Neisen MJ, Johnson MP, Stockland AH, Andrews JC, Misra S, Bjarnason H. Comparison of Covered Versus Uncovered Stents for Benign Superior Vena Cava (SVC) Obstruction. Cardiovasc Intervent Radiol 2018; 41:712-717. [PMID: 29492630 DOI: 10.1007/s00270-018-1906-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/17/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify whether long-term symptom relief and stent patency vary with the use of covered versus uncovered stents for the treatment of benign SVC obstruction. METHODS AND MATERIALS We retrospectively identified all patients with benign SVC syndrome treated to stent placement between January 2003 and December 2015 (n = 59). Only cases with both clinical and imaging follow-up were included (n = 47). In 33 (70%) of the patients, the obstruction was due to a central line or pacemaker wires, and in 14 (30%), the cause was fibrosing mediastinitis. Covered stents were placed in 17 (36%) of the patients, and 30 (64%) patients had an uncovered stent. Clinical and treatment outcomes, complications, and the percent stenosis of each stent were evaluated. RESULTS Technical success was achieved in all cases at first attempt. Average clinical and imaging follow-up in years was 2.7 (range 0.1-11.1) (covered) and 1.7 (range 0.2-10.5) (uncovered), respectively. There was a significant difference (p = 0.044) in the number of patients who reported a return of symptoms between the covered (5/17 or 29.4%) and uncovered (18/30 or 60%) groups. There was also a significant difference (p = < 0.001) in the mean percent stenosis after stent placement between the covered [17.9% (range 0-100) ± 26.2] and uncovered [48.3% (range 6.8-100) ± 33.5] groups. No significant difference (p = 0.227) was found in the time (days) between the date of the procedure and the date of clinical follow-up where a return of symptoms was reported [covered: 426.6 (range 28-1554) ± 633.9 and uncovered 778.1 (range 23-3851) ± 1066.8]. One patient in the uncovered group had non-endovascular surgical intervention (innominate to right atrial bypass), while none in the covered group required surgical intervention. One major complication (SIR grade C) occurred that consisted of a pericardial hemorrhagic effusion after angioplasty that required covered stent placement. There were no procedure-related deaths. CONCLUSION Both covered and uncovered stents can be used for treating benign SVC syndrome. Covered stents, however, may be a more effective option at providing symptom relief and maintaining stent patency if validated by further studies.
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Affiliation(s)
- Mustafa M Haddad
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA.
| | - Benjamin Simmons
- Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Ian R McPhail
- Departments of Cardiology and Vascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Manju Kalra
- Department of Vascular Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Melissa J Neisen
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Matthew P Johnson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Andrew H Stockland
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - James C Andrews
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Sanjay Misra
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Haraldur Bjarnason
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
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Gebreselassie A, Awan A, Yaqoob H, Laiyemo A. Superior Vena Cava Obstruction: A Rare Cause of Recurrent Esophageal Variceal Bleeding. Cureus 2018; 10:e2226. [PMID: 29713571 PMCID: PMC5919766 DOI: 10.7759/cureus.2226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
"Downhill" esophageal varices are formed in upper two-thirds of the esophagus as a consequence of a superior vena cava obstruction. We present a case of 55-year-old African-American female with a medical history of multiple comorbidities, including end-stage renal disease, who presented with an upper gastrointestinal bleed and was found to have distended neck veins on physical examination. She gave a history of the insertion of an intravenous central line in her neck area for hemodialysis purposes about six years previously. An endoscopy showed the presence of esophageal varices and computed tomography (CT) of the abdomen showed the presence of a superior vena cava (SVC) obstruction. The patient was managed supportively. This case represents a rare cause of acute upper gastrointestinal bleeding in an individual with a central line for dialysis leading to SVC thrombosis.
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Affiliation(s)
| | - Ahmad Awan
- Department of Internal Medicine, Howard University Hospital
| | - Hamid Yaqoob
- Department of Internal Medicine, Howard University Hospital
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28
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Majumdar S, Shoela R, Kim DJ, Ramaswamy R, Mani N, Salter A, Akinwande O. Endovascular Management of SVC Syndrome due to Fibrosing Mediastinitis-A Feasibility and Safety Analysis. Vasc Endovascular Surg 2018; 52:202-206. [PMID: 29433409 DOI: 10.1177/1538574418757401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the outcomes of endovascular management for superior vena cava (SVC) syndrome secondary to fibrosing mediastinitis (FM). METHODS Between January 2004 and December 2016, 10 consecutive patients with endovascularly managed SVC syndrome secondary to FM were identified in an institutional database. Venograms were performed to assess the severity and location of the lesion and allow measurement for stent selection. Standard stenting and angioplasty techniques were utilized to establish luminal patency. The safety, feasibility, clinical success, and the primary and secondary patency were evaluated. Kaplan-Meier survival analysis was used to determine median duration of stent patency. A log-rank test was used to test differences in prior stent use. RESULTS Our cohort was predominantly female (7/10) with an average age of 42.2 years. Of the 10 patients, 3 had undergone endovascular stenting at an outside institution prior to referral to our institution due to new, recurrent, or worsening symptoms. All patients underwent venography demonstrating stenosis (8/10) or occlusion (2/10) at initial presentation. Stenting or angioplasty was technically successful in 9 (90.0%) patients. Eight of 10 patients had primary stenting, while 1 achieved vascular patency and symptom resolution with angioplasty alone. Median duration of primary patency was 31.3 months (95% confidence interval: 5.9-103). Six (54.5%) patients required secondary revision procedures. Median duration of secondary patency was 6.1 months, with 25% of revisions occurring by 4 months and 75% occurring by 20.9 months. All treated patients (9/9) reported symptomatic relief at 1-month follow-up, establishing a clinical success rate of 100%. There were no 30-day adverse effects related to the procedure. CONCLUSION This study demonstrates that endovascular therapy is a safe and feasible approach for managing FM-related SVC syndrome.
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Affiliation(s)
- Shamaita Majumdar
- 1 Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA
| | - Ramy Shoela
- 1 Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA
| | - David J Kim
- 1 Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA
| | - Raja Ramaswamy
- 1 Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA
| | - Naganathan Mani
- 1 Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA
| | - Amber Salter
- 1 Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA
| | - Olaguoke Akinwande
- 1 Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA
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Kaba E, Özkan B, Özyurtkan MO, Ayalp K, Toker A. Superior vena cava resection and reconstruction in mediastinal tumors and benign diseases. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:99-107. [PMID: 32082718 PMCID: PMC7018129 DOI: 10.5606/tgkdc.dergisi.2018.14292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to evaluate our results of resection and reconstruction of the superior vena cava invaded by mediastinal tumors and benign diseases. METHODS Seventeen patients (8 males, 9 females; mean age 46±17 years; range 9 to 74 years) undergoing superior vena cava resection and reconstruction due to mediastinal pathologies between September 2006 and September 2016 were retrospectively reviewed. Patients who had angioplasty with primary suturing or partial resection with stapler were excluded. Mortality and morbidity rates were analyzed based on the demographic, and intra- and postoperative measures. RESULTS Majority of patients (94%) had mediastinal tumors. Twelve patients (71%) had thymic epithelial tumors. Tubular graft interposition was performed using ringed polytetrafluoroethylene prosthesis in nine patients (53%), while patch plasty using autologous pericardium, polytetrafluoroethylene or Dacron grafts was performed in eight patients (47%). Eleven patients (65%) necessitated concomitant resections of neighboring structures. Mean length of hospital stay was 11±6 days. There was no intraoperative death. Mortality occurred in three patients (18%). Five patients (29%) developed complications. Mortality occurred commonly in elderly patients (p<0.0001). Postoperative complications were more common in patients with concomitant resections (p=0.05). Neither acute nor chronic thrombosis developed in any patients. Median survival in patients with malignant diseases was 57 months, with a oneyear and three-year probability of survival of 83% and 74%, respectively. CONCLUSION Replacement of superior vena cava should be included in the therapeutic algorithm of selected patients with mediastinal tumors and benign diseases. Mortality rates may be higher in older patients, while the need for concomitant resections may increase morbidity rates.
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Affiliation(s)
- Erkan Kaba
- Department of Thoracic Surgery, İstanbul Bilim University, Faculty of Medicine, İstanbul, Turkey
| | - Berker Özkan
- Department of Thoracic Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Oğuzhan Özyurtkan
- Department of Thoracic Surgery, İstanbul Bilim University, Faculty of Medicine, İstanbul, Turkey
| | - Kemal Ayalp
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Alper Toker
- Department of Thoracic Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, İstanbul, Turkey
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Fichelle JM, Baissas V, Salvi S, Fabiani JN. [Superior vena cava thrombosis or stricture secondary to implanted central venous access: Six cases of endovascular and direct surgical treatment in cancer patients]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 43:20-28. [PMID: 29425537 DOI: 10.1016/j.jdmv.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
Superior vena cava (SVC) stenosis or thrombosis is a well-known complication of central venous catheterization for endocavitary treatments, hemodialysis, or chemotherapy. In cancer patients, these SVC lesions are often symptomatic due to intimal damage and chemotherapy toxicity. We report our experience with six patients treated between 2007 and 2012 via an endovascular approach (n=5) or a direct surgical approach (n=1). All patients had SVC syndrome with facial edema, headache and upper limb edema. In three cases, the catheter was in place when the clinical symptoms occurred. Duplex Doppler and computed tomography (CT)-angiography identified the following lesions: isolated SVC stenosis (n=2); SVC stenosis with right Pirogoff confluence stenosis (n=1); SVC stenosis associated with left innominate vein thrombosis and right Pirogoff confluence stenosis (n=1); SVC thrombosis affecting azygos flow (n=2). In one patient, the thrombus extended into the right atrium. Five patients underwent endovascular repair via a right jugular approach (n=2) or a double jugular approach (n=3). Treatment involved: SVC angioplasty with stent (n=2); right Pirogoff angioplasty and SVC stent (n=1); kissing angioplasty of both innominate trunks with a SVC stent (n=1); and SVC angioplasty without stent because of an incomplete result with a residual lumen less than 8mm (n=1). One patient had a complete SVC occlusion with extension of thrombus into the right atrium. She was treated via a median sternotomy for open surgical control of both innominate trunks and lateral clamping of the right atrium. A long cavotomy prolonged on the right atrium allowed thrombo-intimectomy and pericardial patch angioplasty. Postoperative follow-up was uneventful in five cases. However, postoperative hemorrhage required pericardial drainage in one patient. The CT scan showed a good morphological aspect in five patients and an incomplete result in one case. Patients have been followed up annually with a duplex scan from two to six years. One patient had a restenosis at 7 months treated by a new angioplasty via a femoral approach. A new catheter was positioned via a cervical approach. Two patients died of metastatic diffusion at 8 and 32 months. The other four patients have remained asymptomatic, with a satisfactory duplex scan. In conclusion, VCS lesions after implanted central access for chemotherapy can often be treated endovascularly. Conventional surgery still has indications when lesions extend into the right atrium.
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Affiliation(s)
- J M Fichelle
- Clinique Bizet, 21, rue Georges-Bizet, 75116 Paris, France; Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - V Baissas
- Clinique Bizet, 21, rue Georges-Bizet, 75116 Paris, France; Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - S Salvi
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J N Fabiani
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Left axillary to right atrium anterior chest wall graft using bovine carotid artery conduit. J Vasc Access 2017; 19:187-190. [PMID: 28983897 DOI: 10.5301/jva.5000792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Central venous occlusive (CVO) disease involving the superior vena cava (SVC) and inferior vena cava (IVC) can occur frequently in patients with end-stage renal disease (ESRD) on chronic dialysis. Dialysis access is essential for the survival of these patients. CASE DESCRIPTION We report a case of a chest wall graft creation using bovine carotid artery conduit in a patient who was experiencing life-threatening loss of dialysis access secondary to her SVC and IVC occlusion along with a hypercoagulable state. We did a subcutaneous anterior chest wall graft from the left axillary artery to the right atrium (RA) using a mini thoracotomy incision. CONCLUSIONS ESRD patients with CVO pose a unique challenge. We believe our approach can provide an excellent option for dialysis access in patients with exhausted conventional access options.
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Busto Suárez S, González Gay M, Zanabili Al-Sibbai A, Revuelta Mariño L, Alonso Pérez M. Tratamiento endovascular del síndrome de vena cava superior. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reyes Valdivia A, Garnica Ureña M, Oliva de Anquín E, Rodríguez-Roda Stuart J, Gandarias Zúñiga C. Tratamiento endovascular con estent de síndrome de vena cava superior asociado a cables de marcapasos. Revisión de la literatura. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Primary Stenting Is Not Necessary in Benign Central Venous Stenosis. Ann Vasc Surg 2017; 46:322-330. [PMID: 28807744 DOI: 10.1016/j.avsg.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/09/2017] [Accepted: 07/17/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study is to evaluate central venous stenosis (CVS) etiologies and presentation within a vascular surgery practice. We evaluated endovascular treatment modalities and the patency rates of our interventions. METHODS Five-year retrospective review of endovascular intervention for CVS. Patient demographics, medical comorbidities, and variables were collected including etiology, indwelling device, previous upper extremity (UE) deep venous thrombosis, long-term UE indwelling device (defined as >30 days), malignancy status, hypercoagulable disorders, history of radiation or mediastinal fibrosis or masses, and anticoagulation and/or antiplatelet therapy. Follow-up variables included symptoms, imaging, and anticoagulation and/or antiplatelet utilization. Living patients without recent follow-up were contacted with a telephone survey regarding current symptoms. Patency was evaluated by imaging or clinically by recurrence of signs or symptoms through January 2016. RESULTS A total of 61 patients underwent attempted endovascular CVS interventions from January 2007 to 2013. Forty-seven (83%) patients had successful interventions. There were 22 (36%) end-stage renal disease (ESRD) patients. The primary etiology in 79% of patients was benign CVS secondary to an indwelling device. Eighty-nine percent of the interventions were primary angioplasty (PTA). The overall primary patency rates at 6, 12, and 24 months were 49%, 34%, and 24%, respectively. Secondary patency rates at 6, 12, and 24 months were 97%, 93%, and 88%, respectively. There were no statistical differences in demographics or outcomes in patients treated successfully with PTA or those requiring stenting. There was no statistical difference in the patency rates between ESRD and non-ESRD patients. Previous interventions were not a predictor of loss of patency. CONCLUSIONS Our study supported the rising trend of benign CVS predominantly secondary to indwelling devices. We demonstrated acceptable secondary patency with PTA alone. This study adds further support for a primary angioplasty strategy in treating benign CVS. The optimal endovascular treatment for benign CVS is still undefined.
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Abu-Omar Y, Kocher GJ, Bosco P, Barbero C, Waller D, Gudbjartsson T, Sousa-Uva M, Licht PB, Dunning J, Schmid RA, Cardillo G. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg 2017; 51:10-29. [PMID: 28077503 DOI: 10.1093/ejcts/ezw326] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/24/2022] Open
Abstract
Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.
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Affiliation(s)
- Yasir Abu-Omar
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Gregor J Kocher
- Division of General Thoracic Surgery, Bern University Hospital / Inselspital, Switzerland
| | - Paolo Bosco
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Cristina Barbero
- Department of Cardiovascular and Thoracic Surgery, University of Turin-Italy, Città della Salute e della Scienza-San Giovanni Battista Hospital, Torino, Italy
| | - David Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Miguel Sousa-Uva
- Unit of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon, Portugal
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Ralph A Schmid
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera S. Camillo Forlanini, Lazzaro Spallanzani Hospital, Rome, Italy
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Zubair MM, Duran CA, Peden EK. Superior Vena Cava Reconstruction Using Femoropopliteal Vein as a Panel Graft. Ann Vasc Surg 2017; 44:414.e15-414.e18. [PMID: 28479442 DOI: 10.1016/j.avsg.2017.03.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/01/2017] [Indexed: 11/16/2022]
Abstract
There has been an increase in superior vena cava (SVC) syndrome secondary to the growing use of indwelling catheters and pacemaker wire insertions. These 2 factors can account up to 74% cases of benign SVC syndrome. Endovascular therapy is considered the first line of treatment. Surgery is an excellent option and is generally reserved for SVC syndrome not amenable to traditional endovascular procedures. We report a case of central venous reconstruction including an SVC reconstruction using the femoropopliteal vein as a panel graft in a patient with SVC syndrome due to pacemaker wires who failed multiple endovascular interventions.
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Affiliation(s)
- M Mujeeb Zubair
- Department of Vascular Surgery, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX.
| | - Cassidy A Duran
- Department of Vascular Surgery, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX
| | - Eric K Peden
- Department of Vascular Surgery, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX
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Superior Vena Cava Syndrome Caused by Pacemaker Leads. Ann Thorac Surg 2017; 101:2358-61. [PMID: 27211943 DOI: 10.1016/j.athoracsur.2015.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/04/2015] [Accepted: 09/04/2015] [Indexed: 02/07/2023]
Abstract
Superior vena cava syndrome is one of the rare adverse events associated with pacemaker leads. We describe a 47-year-old woman with a pacemaker implanted 10 years earlier who presented to us with superior vena cava syndrome managed surgically. We report the presentation, diagnosis, and treatment of this patient and the causes and management options of superior vena cava obstruction associated with pacemaker leads.
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Maingard J, Brooks M. Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment. J Med Imaging Radiat Oncol 2017; 61:232-238. [PMID: 28168806 DOI: 10.1111/1754-9485.12592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/26/2016] [Indexed: 11/27/2022]
Abstract
Superior vena cava syndrome (SVCS) is secondary to obstruction of venous flow from the superior vena cava to the right atrium. Endovascular stenting is particularly useful when severe or rapidly progressive disease requires urgent treatment. In suspected mediastinal malignancy, transcaval biopsy can be combined with endovenous stenting to provide diagnosis and treatment in a single procedure. Three patients were referred for investigation and treatment of SVCS over a 20 month period. Under fluoroscopic guidance Cook Medical transjugular biopsy sets (with 20-gauge QuickCore biopsy needles) were used and two or three core biopsy samples were obtained. Stents were utilised to treat SVC obstructions in two of three patients. Obtained samples were adequate for histological diagnosis. Diagnoses included small cell and small cell neuroendocrine carcinoma of the lung. No procedural complications were encountered. Importantly, no further invasive diagnostic procedures were required. This is a safe and effective alternative to obtain a histological diagnosis in malignant SVCS and in the appropriate clinical setting biopsy can be combined with SVC stenting in a single procedure.
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Affiliation(s)
- Julian Maingard
- Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Mark Brooks
- Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
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Large vein reconstructions in the endovascular era. PHLEBOLOGIE 2017. [DOI: 10.12687/phleb2351-1-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SummaryMax Ratschow was a remarkable physician and an international authority in the field of angiology and the Ratschow lectureship helps to fulfill this pioneer’s life purpose: to advance evaluation and treatment of vascular diseases. The 2017 Max Ratschow lecture covers some recent advances and controversies in venous diseases. Phlebology, once a neglected field of angiology, is a discipline that has been in constant progress during the past decades. Endovascular techniques revolutionized treatment of patients with large vein obstruction and provided safe, minimally invasive procedures with excellent long term results. Attention now need to focus on comparative studies to provide scientific evidence of efficacy of venous angioplasty and stenting with properly organized randomized controlled trials. Further attempts are needed to develop special venous stents and to decrease thrombotic complications and formation of pseudointima that cause in-stent restenosis. Open and hybrid reconstructions are safe and durable, but the number of procedures in general is small and special training and expertise for reconstructive venous surgery is recommended. Autologous vein should be used for infrainguinal reconstructions and for treatment of unilateral iliac vein obstruction with a femoro-femoral cross-over bypass (Palma procedure). IVC and iliac vein reconstructions with ePTFE grafts provide superb result in patients who need excision of malignant tumors invading large veins. Open and hybrid reconstructions are here to stay and they remain excellent options for those patients who are unsuitable for or fail endovascular repair.
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A Review of Open and Endovascular Treatment of Superior Vena Cava Syndrome of Benign Aetiology. Eur J Vasc Endovasc Surg 2016; 53:238-254. [PMID: 28007450 DOI: 10.1016/j.ejvs.2016.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/13/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND The widespread use of central venous catheters, ports, pacemakers, and defibrillators has increased the incidence of benign superior vena cava syndrome (SVCS). This study aimed at reviewing the results of open and endovascular treatment of SVCS. METHOD Medical literature databases were searched for relevant studies. Studies with more than five adult patients, reporting separate results for the SVC were included. Nine studies reported the results of endovascular treatment of SVCS including 136 patients followed up for a mean of 11-48 months. Causes of SVCS were central venous catheters and pacemakers (80.6%), mediastinal fibrosis (13.7%), and other (5.6%). Percutaneous transluminal angioplasty (PTA) and stenting was performed in 73.6%, PTA only in 17.3%, and thrombolysis, PTA, and stenting in 9%. Four studies reported the results of open repair of SVCS including 87 patients followed up between 30 months and 10.9 years. The causes were mediastinal fibrosis (58.4%), catheters and pacemakers (28.5%), and other (13%). Operations performed included a spiral saphenous interposition graft, other vein graft, PTFE graft, and human allograft. Thirteen patients required re-operations (15%) before discharge mainly for graft thrombosis. RESULTS In the endovascular group technical success was 95.6%. Thirty day mortality was 0%. Regression of symptoms was reported in 97.3%. Thirty-two patients (26.9%) underwent 58 secondary procedures. In the open group the 30 day mortality was 0%. Symptom regression was reported in 93.5%. Twenty-four patients (28.4%) underwent a total of 33 secondary procedures. CONCLUSIONS Endovascular is the first line treatment for SVCS caused by intravenous devices, whereas surgery is most often performed for mediastinal fibrosis. Both treatments show good results regarding regression of the symptoms and mid-term primary patency, with a significant incidence of secondary interventions.
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Gallo M, Protos AN, Trivedi JR, Slaughter MS. Surgical Treatment of Benign Superior Vena Cava Syndrome. Ann Thorac Surg 2016; 102:e369-71. [PMID: 27645987 DOI: 10.1016/j.athoracsur.2016.03.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 02/26/2016] [Accepted: 03/30/2016] [Indexed: 11/25/2022]
Abstract
The obstruction of blood flow through the superior vena cava (SVC) into the right atrium may present as a severe clinical syndrome. One of the benign causes of SVC obstruction is the long-term use of indwelling catheters and wires, increasing the chances of SVC thrombosis. The treatment of the benign SVC syndrome is focused on achieving long-term durability and patency of the superior venocaval system and normal life expectancy. We report the successful surgical management of a patient with severe symptomatic SVC syndrome and emphasize technical details that might be of value in treating this challenging pathologic condition.
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Affiliation(s)
- Michele Gallo
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Adam N Protos
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jaimin R Trivedi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
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Arabi M, Ahmed I, Mat’hami A, Ahmed D, Aslam N. Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience. Cardiovasc Intervent Radiol 2015; 39:927-34. [DOI: 10.1007/s00270-015-1270-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
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Sonavane SK, Milner DM, Singh SP, Abdel Aal AK, Shahir KS, Chaturvedi A. Comprehensive Imaging Review of the Superior Vena Cava. Radiographics 2015; 35:1873-92. [DOI: 10.1148/rg.2015150056] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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44
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Superior Vena Cava Reconstruction for Treatment of Chylothorax Resulting From Thrombosis of Superior Vena Cava in Young Infants. Ann Thorac Surg 2015; 100:1432-6. [DOI: 10.1016/j.athoracsur.2015.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/21/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
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Ojeifo O, Gilotra NA, Kemp CD, Leventhal A, Resar J, Zehr KJ, Jones S. Mediastinal Fibrosis of the Pulmonary Artery Secondary to Tuberculosis. Ann Thorac Surg 2015; 100:e49-50. [DOI: 10.1016/j.athoracsur.2015.03.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/19/2015] [Accepted: 03/25/2015] [Indexed: 11/30/2022]
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46
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Elias HK, Jan MF, Allaqaband SQ. Role of endovascular stenting in radiation-induced stenosis of lower extremity veins. Catheter Cardiovasc Interv 2015; 86:312-5. [DOI: 10.1002/ccd.25671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/19/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Harold K. Elias
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
| | - M. Fuad Jan
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
| | - Suhail Q. Allaqaband
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
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Mokry T, Bellemann N, Sommer CM, Heussel CP, Bozorgmehr F, Gnutzmann D, Kortes NA, Kauczor HU, Radeleff B, Stampfl U. Retrospective study in 23 patients of the self-expanding sinus-XL stent for treatment of malignant superior vena cava obstruction caused by non-small cell lung cancer. J Vasc Interv Radiol 2015; 26:357-65. [PMID: 25638748 DOI: 10.1016/j.jvir.2014.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/17/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate retrospectively the self-expanding nitinol Sinus-XL stent (OptiMed, Ettlingen, Germany) for the treatment of superior vena cava (SVC) obstruction caused by non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Between October 2009 and December 2012, 23 patients (7 women and 16 men; age, 62.5 y ± 8.5) with stage IIIA (1 patient), IIIB (4 patients) or IV (18 patients) NSCLC and acute SVC obstruction were scheduled for urgent stent implantation. The primary study endpoints were technical success (defined as accurate stent placement with complete coverage of the obstructed SVC), residual stenosis < 30%, and clinical efficacy. Complications were assessed as a secondary study endpoint. RESULTS There were 26 stents implanted in 23 patients. The technical success was 100%. Stent dilation was performed after deployment in 18 cases (78%). Stent migration into the right atrium occurred immediately after deployment in one patient; however, this stent was successfully repositioned and stabilized by a second stent. The clinical symptoms improved at least one category according to the International Consensus Committee on Chronic Venous Disease after stent implantation in all but one patient. The mean clinical follow-up was 66 days ± 83 (range, 1-305 d). Three minor complications (13%) and one major complication (4%) occurred. CONCLUSIONS Implantation of the self-expanding Sinus-XL stent for treatment of SVC obstruction caused by NSCLC is a safe and effective urgent treatment in this palliative setting.
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Affiliation(s)
- Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Nadine Bellemann
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Claus P Heussel
- Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxlinik University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Daniel Gnutzmann
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Nikolas A Kortes
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Hans U Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Ulrike Stampfl
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Massmann A, Rostam A, Fries P, Buecker A. A wire transposition technique for recanalization of chronic complex central venous occlusions. Phlebology 2014; 31:57-60. [PMID: 25178813 DOI: 10.1177/0268355514550260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE A minimal-invasive interventional technique for recanalization of complex chronic central venous total occlusions is described to overcome difficulties in case of failure of common approaches. METHOD We present a patient with a central venous occlusion that caused severe venous congestion of her upper extremity and significant impairment of her forearm hemodialysis shunt. Since the usual transbrachial and transfemoral attempts for recanalization of occluded right subclavian, brachiocephalic, superior vena cava, and proximal internal jugular veins (IJV) failed, the approach was changed to a transjugular access. Only the IJV and subclavian vein occlusions were passed from transjugular. RESULTS The key procedure was the switch of a jugular-brachial wire to a femoral-brachial setting. The wire transposition was achieved by snaring the looped stiff end of the jugular-brachial wire outside the jugular sheath from the opposite femoral access. CONCLUSION Different approaches should be considered for the recanalization of challenging central venous occlusions. After failed attempts via common access sites, a guidewire transposition maneuver using a combined approach may be particularly helpful for safe and effective endovascular treatment of complex situations.
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Affiliation(s)
- A Massmann
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - A Rostam
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - P Fries
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - A Buecker
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
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FU HAIXIA, HUANG XINMIAO, ZHONG LI, OSBORN MICHAELJ, BJARNASON HARALDUR, MULPURU SIVA, ZHAO XIANXIAN, FRIEDMAN PAULA, CHA YONGMEI. Outcome and Management of Pacemaker-Induced Superior Vena Cava Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1470-6. [DOI: 10.1111/pace.12455] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/15/2014] [Accepted: 05/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- HAI-XIA FU
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
- Department of Cardiovascular Diseases; Henan Provincial People's Hospital; Henan China
| | - XIN-MIAO HUANG
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
- Department of Cardiovascular Diseases; Changhai Hospital; Second Military Medical University; Shanghai China
| | - LI ZHONG
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
- Department of Cardiology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - MICHAEL J. OSBORN
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - HARALDUR BJARNASON
- Division of Cardiovascular Diseases; Department of Radiology; Mayo Clinic; Rochester Minnesota
| | - SIVA MULPURU
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - XIAN-XIAN ZHAO
- Department of Cardiovascular Diseases; Changhai Hospital; Second Military Medical University; Shanghai China
| | - PAUL A. FRIEDMAN
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - YONG-MEI CHA
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
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del Río Solá ML, Fuente Garrido R, Gutiérrez Alonso V, Vaquero Puerta C. Endovascular treatment of superior vena cava syndrome caused by malignant disease. J Vasc Surg 2014; 59:1705-6. [PMID: 24836767 DOI: 10.1016/j.jvs.2013.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 11/16/2022]
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