Superior Vena Cava Reconstruction for Treatment of Chylothorax Resulting From Thrombosis of Superior Vena Cava in Young Infants

Abstract

Thrombotic occlusion of the SVC can result in chylothorax that is often not amenable to medical therapy. This is associated with significant loss of proteins and hypercoagulable state. A complete surgical relief of SVC obstruction by open thrombectomy and venoplasty can result in dramatic decrease in chylous output.

Intravascular Stent Implantation as Effective Therapy for Refractory Chylothorax Secondary to Congenital Superior Vena Cava Stenosis in an Infant

“…The most common site for this type of obstruction is the innominate vein [6], but as demonstrated in this case, the SVC are acquired rather than congenital. The three most common etiologies are thrombosis surrounding a port or central line, external compression from tumors or other mass effect, and surgical complications including direct injury of the thoracic duct or postoperative stenosis of the SVC or innominate vein [4,7,8,9,10]. Congenital-rather than acquired-SVC stenosis as presented in our case is exceedingly rare and thus far has only been reported in the presence of other significant cardiac anomalies.…”

Stent‐retriever thrombectomy in the treatment of infants with acute thrombosis of the superior vena cava and innominate vein

“…Interventions have to be performed early since any delay may result in thrombus organization and render thrombectomy ineffective . In more advanced states of thrombosis, surgical therapy may require reconstruction and patch augmentation of the SVC, which has to be performed on cardiopulmonary bypass …”

“…1 In more advanced states of thrombosis, surgical therapy may require reconstruction and patch augmentation of the SVC, which has to be performed on cardiopulmonary bypass. 21 During the recent years, a number of different interventional approaches have been reported to avoid repeat surgery in these critically ill children. Since systemic thrombolytic therapy is associated with significantly increased risk of bleeding in the early postoperative period, [22][23][24] attempts have been made to revascularize the SVC by application of local thrombolytic therapy with urokinase or rt-PA. 9 Good results were reported when local thrombolytic therapy with rt-PA was combined with percutaneous endovascular catheter aspiration thrombectomy.…”

Chylothorax as a Risk Factor for Thrombosis in Adults: A Proof-of-Concept Study

“…Data on the association of thrombosis and chylothorax in adults are sparse. In the absence of a clear risk factor for chylothorax (eg, thoracic operation), most associations of chylothorax and vascular thrombosis are with a primary central venous thrombosis that secondarily leads to thoracic duct obstruction and, consequently, chylothorax [7,[17][18][19][20][21][22]. There are only rare case reports from the adult population that describe de novo vascular thrombosis arising after development of the chylothorax.…”