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Published on: December 23, 2014
Percutaneous superior vena cava puncture successful recanalization of a long-segment, angled central venous
Xiao-Rong Huang1, Qian Ren2, Ji-Bo Sun2
1Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China; West China School of Nursing, Sichuan University, Chengdu, China.
Insights
A novel bidirectional approach using superior vena cava (SVC) puncture for percutaneous transluminal angioplasty (PTA) successfully treated a hemodialysis patient with complete central venous occlusion (CVO). This technique offers a new option for challenging CVO cases.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Complete central venous occlusion (CVO) is a rare but serious complication in hemodialysis patients.
- Percutaneous transluminal angioplasty (PTA) is the standard treatment, but long-segment occlusions present significant challenges.
Observation:
- A 76-year-old male hemodialysis patient presented with a significantly swollen right arm due to CVO involving the innominate, subclavian, and jugular veins.
- Digital subtraction angiography confirmed extensive venous occlusion and stenosis, rendering standard PTA approaches difficult.
Findings:
- A pioneering bidirectional PTA approach was successfully employed, utilizing both superior vena cava (SVC) and axillary vein (AV) puncture.
- Complete recanalization of the occluded venous segments was achieved, resolving the patient's symptoms.
Implications:
- This case demonstrates the first reported use of SVC puncture in PTA for CVO.
- This technique represents a viable and potentially crucial treatment option for complex CVO cases when other options are exhausted.
Background:
Multiple complete central venous occlusion (CVO) is rare complication among the hemodialysis population. Percutaneous transluminal angioplasty (PTA) is the recommended treatment for CVO; however, cases with long-segment occlusion remain challenging.
Case Description:
We reported a patient who complained of a swollen right arm for 1 month. On admission, his vital signs were within normal limits. The 76-year-old man had been on hemodialysis with a right forearm arteriovenous fistula (AVF) for 4 years with a history of temporizing catheterization and left forearm AVF failure. One year ago, he gradually developed a slight swelling in his right arm and the swelling in his arm was significantly worse one month ago. Digital subtraction angiography (DSA) revealed occlusion in his right innominate vein (IV), proximal subclavian vein (SV), and external and internal jugular veins, as well as stenosis of the ipsilateral cephalic arch and axillary vein (AV). The operation was performed with a pioneered bidirectional approach via ipsilateral superior vena cava (SVC) and AV puncture. The occluded lesions were successfully recanalized, and the patient's symptoms resolved after the operation. The patency of his vascular access was well maintained at the 4-month follow-up.
Conclusions:
To the best of our knowledge, this is the first report regarding the application of SVC puncture in PTA for CVO. This technique could be a possible approach when performed by appropriately qualified operators in patients with limited or no other options.
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