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Diathermy-assisted recanalization of chronic superior vena cava obstruction, case report
Reda Abuelatta1, Amal A Sakrana2, Shadha A Al-Zubaidi1
1Madinah Cardiac Center, Khaled Bin Waleed Street, PO 6167, Madinah Saudi Arabia.
Insights
Diathermy successfully recanalized a chronic total superior vena cava (SVC) obstruction in a benign SVCS case. Endovascular stenting restored SVC flow, proving a safe and effective initial treatment for SVCS.
Area of Science:
- Cardiology
- Interventional Radiology
Background:
- Superior vena cava syndrome (SVCS) is increasingly prevalent due to cardiac device and central venous catheter use.
- Management strategies for benign SVCS remain debated, necessitating novel approaches.
Observation:
- A 51-year-old male with ischemic cardiomyopathy and chronic renal failure presented with progressive upper body swelling and dyspnea.
- Venography confirmed a completely occluded superior vena cava (SVC).
Findings:
- A novel technique using diathermy via an electrocautery pen and guidewire successfully recanalized the chronic total SVC obstruction.
- Placement of two stents resulted in complete restoration of SVC blood flow, confirmed by angiography.
Implications:
- Diathermy is a feasible and safe method for crossing chronic total SVC occlusions.
- Endovascular techniques represent a suitable and effective option for the initial management of benign SVCS.
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.
