Intermittent Echocardiographic Monitoring During Superior Vena Cava Recanalization: A Protocol for Early Recognition...

Endovascular recanalization and stent reconstruction constitute an effective and safe treatment option for symptomatic thoracic central venous obstruction (TCVO). Rare life-threatening adverse events are possible during or immediately following the procedure, with the most feared one being hemopericardium with cardiac tamponade. A technique to improve efficiency in detection and treatment of cardiac tamponade is described.

An institutional protocol was established for intraprocedural transthoracic echocardiographic monitoring during the TCVO recanalization procedures. The lower chest and upper abdomen were prepared within the sterile field. A separate stand was set up with unopened supplies needed for pericardial drain placement. Intermittent echocardiographic monitoring was performed throughout the TCVO procedure using a dedicated curvilinear probe prepared on the field. If indicated, an image guided pericardial drain was placed expeditiously.

Four cases of cardiac tamponade were encountered during or immediately post-procedure. All cases demonstrated technically successful and prompt pericardial drain placement with immediate reversal of the tamponade physiology.

Echocardiographic monitoring during TCVO reconstruction by interventional radiologists is a useful technique which may aid in early diagnosis and management of cardiac tamponade.