Emergency Venous Angioplasty of a Complete Superior Vena Cava Thrombosis

J INVASIVE CARDIOL 2019;31(6):E158.

Key words: computed tomography angiography, thrombus

An 80-year-old patient was admitted to our emergency department due to progressive dyspnea, chest pain, and livid swelling of the upper limbs and the face within the past 24 hours (Figure 1A). He had a history of colon carcinoma and underwent subcutaneous implantation of a central venous port (CVP) device into the right subclavian vein for administration of systemic chemotherapy several months prior. Thoracic computed tomography scan revealed a 2.8 cm-long thrombus arising from the tip of the venous catheter, which completely occluded the superior vena cava (SVC) in close proximity to the right atrium, triggering the formation of multiple collaterals in the upper chest (Figures 1B and 1C; Video 1). Due to progressive respiratory distress and hypotension, he underwent an emergency venous balloon angioplasty through transfemoral access (Figures 1D-1F) after initiation of anticoagulation with unfractionated heparin. Immediately after balloon dilation (maximum balloon diameter, 18 mm) (Video 2) and reoccurrence of blood flow (Figure 1F; Video 3) through the SVC, all symptoms resolved within minutes (Figure 1G). After 3 days, the CVP was surgically removed, as it was no longer needed for chemotherapy application and the patient was discharged on anticoagulation with low-molecular-weight heparin for 3 months.

View the Accompanying Video here.

From the ¹Klinikum der Universität München, I. Medizinische Klinik und Poliklinik and Munich Heart Alliance, Munich, Germany.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted December 6, 2018.

Address for correspondence: Dr. med. Tobias Petzold, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, D-81377, Munich, Germany. Email: Tobias.Petzold@med.uni-muenchen.de