Saccular aneurysm of superior vena cava treated with percutaneous, transcatheter thrombin injection

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Superior vena cava (SVC) aneurysms are rare and pose significant surgical risks.
• Vascular malformations can complicate management of adjacent vascular lesions.
• Endovascular intervention is considered for high-risk surgical candidates.

Observation:

• A large saccular aneurysm of the SVC was identified in a patient with coexisting vascular malformations of the right hand and chest.
• Venography confirmed a direct communication between the aneurysm and the SVC, distal to the brachiocephalic confluence.
• The patient presented with a high surgical risk profile.

Findings:

• Successful endovascular treatment was achieved using balloon-protected transcatheter thrombin injection.
• The procedure involved selective catheterization of the aneurysm and balloon occlusion of the SVC.
• Post-treatment follow-up revealed initial slight enlargement followed by significant shrinkage of the aneurysm within a year.

Implications:

• Endovascular therapy with thrombin injection is a viable and effective treatment for large SVC aneurysms, especially in high-risk patients.
• This technique offers a less invasive alternative to open surgery for complex vascular lesions.
• Minimally invasive approaches can lead to favorable long-term outcomes in managing SVC aneurysms associated with vascular malformations.