Long-term Patency of Venous Stent After Sharp Recanalization for Benign Superior Vena Cava Occlusion

The incidence of benign superior vena cava syndrome (SVCS) is increasing due to the widespread use of central venous catheters and cardiac devices. Endovascular therapy is a first-line treatment option; however, recanalization of a completely occluded SVC remains technically challenging, and long-term stent patency data are limited. We report a case of central venous catheter-related benign SVCS treated with stent placement using a sharp recanalization technique and present the resulting 10-year patency outcome.

A male patient in his 50s presented with facial and upper extremity edema secondary to benign SVCS caused by repeated central venous catheter placement for short-bowel syndrome. Venography revealed complete SVC occlusion (modified Stanford type 4). Sharp recanalization using a trans-septal needle was performed under biplane fluoroscopy and cone-beam computed tomography guidance, followed by placement of a self-expanding bare-metal stent (14 × 40 mm). Symptoms resolved the following day. In-stent re-stenosis occurred at 10 months and was successfully managed with balloon dilatation, after which the stent remained patent with no recurrence of SVCS on annual follow-up. Long-term patency of the stent was achieved for the next 10 years.

Sharp recanalization using a trans-septal needle enabled safe and effective stent placement for completely occluded benign SVC. Long-term stent patency of 10 years was achieved with a single re-intervention, demonstrating that this technique is a viable treatment option for benign SVCS.