Korean J Radiol.  2014 Jun;15(3):364-369. 10.3348/kjr.2014.15.3.364.

Dialysis Catheter-Related Superior Vena Cava Syndrome with Patent Vena Cava: Long Term Efficacy of Unilateral Viatorr Stent-Graft Avoiding Catheter Manipulation

• Quaretti P
• Galli F
• Moramarco
• Corti R
• Leati G
• Fiorina I
• Maestri M

• KMID: 2078646
• DOI: http://doi.org/10.3348/kjr.2014.15.3.364

Abstract

Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

Keyword

Central venous stenosis; Stent-graft; Central venous catheter; Dialysis; Superior vena cava syndrome

MeSH Terms

Aged
Brachiocephalic Veins
Central Venous Catheters/*adverse effects
Constriction, Pathologic/etiology
Female
Humans
Jugular Veins
Renal Dialysis/instrumentation
*Stents
Superior Vena Cava Syndrome/*etiology/therapy
Vena Cava, Superior

Figure

• 

  Fig. 1 Angiographic and schematic illustration of procedure. A. Diagnostic angiography through distal right internal jugular vein injection shows occlusion of right brachiocephalic vein around twin catheter and inverted flow in internal jugular vein (arrow). B. Schematic drawing illustrates initial situation with pericatheter thrombosis involving right internal jugular vein, right subclavian vein and right brachiocephalic vein around well functioning twin catheter. C. Venography from left internal jugular vein reveals critical stenosis of distal left brachiocephalic vein with proximal collateral pathways and patent superior vena cava (arrow). D. Draw illustrates 8 mm predilation of left brachiocephalic lesion performed from left internal jugular vein access subsequently followed by immediate and complete elastic recoil. E. Leading bare end of stent-graft (arrowhead) is open after retrieval of 10-Fr introducer at fluoroscopy snap shot during transfemoral stent-graft releasing. F. Schematic drawing shows free-flow leading end of stent-graft in front of opening to left internal jugular vein. G. Final venography from left internal jugular vein introducer shows direct free flow in right atrium through leading bare end (arrowhead) of Viatorr stent-graft. H. Draw represents final situation with expanded stent-graft permitting flow from left internal jugular vein and left brachiocephalic vein. I. Axial contrast-enhanced multidetector computed tomography performed at 60 months for breast cancer follow-up showing stent-graft (arrow) patency and twin catheter (star). J. Curved multi-planar reconstruction through longitudinal axis of Viatorr stent-graft confirms stent patency (arrowhead) and twin catheter (star) in site.

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