The dangerous liaisons between central venous stents and catheters: a case report

Endovascular stenting is the standard of care for superior vena cava (SVC) obstruction, providing rapid symptom relief and high technical success rates. However, no guidelines exist for the concurrent use of centrally inserted central catheters (CICCs) within stents or for optimal antithrombotic strategies. We report a case of a 69-year-old woman with malignant Superior Vena Cava Syndrome (SVCS) treated with a central venous stent (CVS) placement who subsequently required a jugular CICC for antibiotic therapy. Six days later, she developed recurrent edema. Imaging revealed extensive thrombosis involving the stent and adjacent veins, while ultrasound demonstrated a prominent fibroblastic sleeve (fibrin sheath) at the catheter entry site. Despite thrombo-aspiration and catheter removal, the sleeve persisted, exhibiting the characteristic "ghost sign." Additional kissing stents restored partial patency, and anticoagulation was resumed.This case underscores the potential risks of placing a CICC within a previously inserted CVS. The coexistence of thrombosis and a fibroblastic sleeve on the same catheter-reported here for the first time-suggests that these entities, although distinct, can occur together. It is plausible that the flow reduction caused by the fibroblastic sleeve may increase the risk of thrombus formation, thereby raising the likelihood of stent thrombosis and recurrent SVCS. Imaging revealed that a fibroblastic sleeve, recognizable by the "ghost sign," persisted even after catheter removal, underscoring the diagnostic and therapeutic challenges of distinguishing it from thrombosis. Current guidelines do not address this situation, and data are limited. Until more evidence is available, clinicians should consider alternative access options-such as Femorally Inserted Central Catheters (FICCs)-when CVS are present and manage anticoagulation carefully. Multidisciplinary teamwork and regular follow-up are essential to improve outcomes and prevent recurrence.