Femoral Vein Approach for Treating Superior Vena Cava Syndrome With Occlusion and Atretic Innominate Vein and Inferior Vena Cava

Introduction: Superior vena cava syndrome (SVCS) is a collection of signs and symptoms caused by a mechanical obstruction of the SVC. Obstruction of the SVC can be acute or chronic, with the most common cause being malignancy. Typically, masses around the SVC will externally compress the vessel, leading to collateral diversion of blood flow. Rarely, large thrombi can form and lead to SVCS.

Case Presentation: This is a case report of a 26-year-old man with SVCS secondary to thrombi formation, successfully treated with balloon angioplasty after attempting to recanalize the SVC with a stent. He had a history of DiGeorge syndrome status post surgical correction of a congenital heart defect, hypertension, and depression. He presented to an outside emergency center with facial swelling of 1 week. Swelling started solely on his face and progressed to both of his arms during this period. Imaging was done 1 week later at the outside emergency center, which showed evidence of SVCS with occlusion and atretic innominate vein and inferior vena cava. The patient was transported to our institution for a higher level of care. An attempt to recanalize the SVC via right inferior jugular vein approached for SVC stent placement was unsuccessful, so the patient underwent SVC recannulation via a femoral approach. The SVC stenosis/compression was about 90% to 95%. By the end of the recannulation, the stenosis was reduced to 30% using wire crossing and balloon angioplasty. Postoperatively, the patient experienced resolution of presenting symptoms and was discharged the next day.

Conclusion: In conclusion, the most common symptoms of SVCS are dyspnea, cough, dilated chest veins, and swelling of the face, neck, and arm. Patients presenting with clinical features suspect of SVCS should undergo chest radiography followed by computed tomography of the chest to delineate the cause of SVCS. Method of management will often revolve around the etiology that is causing the compression of the SVC, such as recanalization with a stent. A femoral approach for SVC recannulation may be more superior than internal jugular vein approach recannulation for patients with SVCS with thrombotic occlusion of the IVC. It appears from our case and case series that our approach demonstrates efficiency in treating SVCS utilizing fewer devices, radiation, and contrast when compared with the published data.