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Case Reports
. 2020 Jun 7;15(8):1168-1172.
doi: 10.1016/j.radcr.2020.05.002. eCollection 2020 Aug.

Diathermy-assisted recanalization of chronic superior vena cava obstruction, case report

Reda Abuelatta  1 , Amal A Sakrana  2 , Shadha A Al-Zubaidi  1 , Mohammed Abdelhalim  1 , Hesham Abdo Naeim  1
Affiliations
Case Reports

Diathermy-assisted recanalization of chronic superior vena cava obstruction, case report

Reda Abuelatta et al. Radiol Case Rep. .

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.

Keywords: Diathermy; Stenting; Superior vena cava; Venous obstruction.

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Figures

Fig. 1 –
Fig. 1
(A) Prominent right internal mammary vein and left superior intercostal vein. (B) Prominent azygous vein. (C) Collateral at diaphragmatic veins. (D) Anterior Superficial chest /abdominal walls venous anastomoses. (E) MDCT coronal-oblique reformatted image. Upper arrow pointed to the prominent right external jugular vein, the middle arrow is distal SVC obstruction at post azygous junction and the lower arrow is collateral at pericardophrenic vein with diaphragmatic veins.
Fig. 2 –
Fig. 2
(A) SVC injection showed a total obstruction. (B) Extensively fibrosed and long segment of 21 mm of total obstruction. (C) Intermitted pulses of diathermy applied till the outlet of the obstruction in the SVC crossed. (D) The wire was snared from the left IJV access, exteriorized creating a venovenous loop. (E) Incremental balloons started with coronary 2-mm balloons. (F) Catheter crossed after many balloons' dilations.
Fig. 3 –
Fig. 3
(A) The blood flow started to appear in SVC. (B) Larger balloon dilation. (C and D) First 39-mm CP (NuMed, Canada) bare stent. (E) Second 39mm CP (NuMed, Canada) bare stent. (F) Final result with full restoration of SVC flow.
See this image and copyright information in PMC

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