Korean J Radiol.  2011 Oct;12(5):629-633. 10.3348/kjr.2011.12.5.629.

Stenting of the Superior Vena Cava and Left Brachiocephalic Vein with Preserving the Central Venous Catheter in Situ

• Isfort P
• Penzkofer
• Goerg F
• Mahnken AH

• KMID: 1116450
• DOI: http://doi.org/10.3348/kjr.2011.12.5.629

Abstract

Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.

Keyword

Central venous stenosis; Venous PTA and stenting; Central venous catheter protection

MeSH Terms

Brachiocephalic Veins/*pathology
Carcinoma, Bronchogenic/complications/drug therapy
*Catheterization, Central Venous/methods
Catheters, Indwelling
Constriction, Pathologic
Endovascular Procedures/*methods
Humans
Lung Neoplasms/drug therapy
Male
Middle Aged
Palliative Care
*Stents
Vena Cava, Superior/*pathology

Figure

• 

  Fig. 1 Angiographic and schematic illustration of procedure. A. Diagnostic angiography showing severe stenosis of superior vena cava (arrow). B. Diagnostic angiography of left brachiocephalic vein reveals subtotal stenosis (arrows). C. After repositioning tip of port-catheter into right brachiocephalic vein using 15 mm Andra-snare, self-expandable stent is placed in superior vena cava (arrows). D. Left jugular vein is punctured and 7 Fr introducer sheath is introduced (arrowhead). Released stent in superior vena cava (arrow). E. Using Andra-snare (arrow), port-catheter (arrowhead) is repositioned in distal part of left brachiocephalic vein and is fixed there by keeping loop-wire of snare around port catheter, while snare's catheter is removed. F. Left brachiocephalic vein stenosis is crossed with guide-wire via same sheath while snare's loop wire remains in place and two 12 mm stents (arrow) are placed via same introducer sheath in left brachiocephalic vein, extending from superior vena cava to left brachiocephalic vein. Finally snare's catheter is inserted again and port catheter is repositioned into superior vena cava (arrowhead). G-J. Schematic drawing of procedure. Initial situation with stenosis in superior vena cava and left brachiocephalic vein and in situ port catheter (G). Port catheter is repositioned in right brachiocephalic vein using snare before stent is placed in superior vena cava (H). Then port catheter is positioned in distal part of left brachiocephalic vein and two stents are placed in left brachiocephalic vein and superior vena cava via same sheath (I). Final situation with preserved port catheter (J).

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