Combined rheolytic thrombectomy and stent placement in SVC and brachiocephalic vein thrombosis due to metastatic lymphadenopathy

Ptohis, Nikolaos; Lechareas, Symeon; Poulou, Loukia S.; Pagoni, Stamatina; Charalampopoulos, Georgios; Filippiadis, Dimitrios

doi:10.2484/rcr.v10i1.991

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“…To manage patients successfully in short term, options include angioplasty, mechanical thrombectomy, thrombolysis and venous stenting (Dib and Hennebry 2012). With our patient, we chose to perform AngioJet™ (Boston Scientific, Marlborough, MA) rheolytic thrombectomy in conjunction with kissing stents to alleviate acute venous congestion and decrease thrombotic burden that could become pulmonary emboli (Ptohis et al 2015). This method provides immediate decompression of the obstruction and maintains patency of the superior vena cava when external compression from a tumor was likely the cause of thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Treatment of superior vena cava syndrome using AngioJet™ thrombectomy system

et al. 2019

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Background: Superior vena cava syndrome is a relatively rare presentation in which diminished venous return to the heart produces congestion of the neck, face and upper extremities. Typically, a mediastinal mass produces external compression on the superior vena cava and reduces venous return. However, superior vena cava syndrome can present acutely in the setting of vena cava thrombosis. Multiple scoring systems are available to assist clinicians with appropriate timing of interventions for SVC syndrome. When specific criteria are met, endovascular intervention can be beneficial to patients to prevent rapid deterioration. Case presentation: A 75-year-old female with no significant past medical history presented to the emergency department with increased facial swelling, nausea and vomiting which began the night prior to presentation. The patient underwent a CT chest which revealed a 3.2 × 3.0 × 3.8 cm spiculated mass compressing the right main bronchus and right pulmonary artery. The patient was intubated and interventional radiology was consulted. The patient underwent venography which showed extensive thrombosis of the innominate veins. Rheolytic thrombectomy with AngioJet™ was performed to alleviate clot burden and minimize risk of secondary pulmonary embolism. Kissing stents were placed in the bilateral innominate veins to maintain patency after thrombectomy. After the procedure, the patient was successfully extubated and had near complete resolution of facial swelling approximately 12 h post procedure. A follow up venogram performed on post procedure day 4 showed patent bilateral subclavian, innominate, and internal jugular veins as well as a patent superior vena cava. Conclusions: Acute occlusion of superior vena cava can present with life threatening symptoms such as loss of airway. AngioJet™ thrombectomy is another tool available to interventional radiologists when a patient's clinical condition necessitates treatment.

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Section: Introductionmentioning

confidence: 99%