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1.
Card Electrophysiol Clin ; 16(2): 139-142, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38749632

RESUMO

This case report discusses a 42-year-old male with dextro-transposition of the great arteries (D-TGA) status post Mustard repair and sick sinus syndrome status post dual-chamber pacemaker implant, who developed symptomatic superior vena cava (SVC) baffle stenosis. He was treated with a combined pacemaker extraction and subsequent SVC baffle stenting. The case highlights the complexities of treating SVC baffle stenosis in the presence of cardiac implantable devices and demonstrates the efficacy of this combined approach. Furthermore, the authors delve into the intricacies of D-TGA, its surgical history, and the long-term complications associated with atrial switch procedures.


Assuntos
Remoção de Dispositivo , Marca-Passo Artificial , Stents , Transposição dos Grandes Vasos , Humanos , Transposição dos Grandes Vasos/cirurgia , Masculino , Adulto , Marca-Passo Artificial/efeitos adversos , Síndrome da Veia Cava Superior/cirurgia , Síndrome da Veia Cava Superior/etiologia , Síndrome do Nó Sinusal/terapia , Síndrome do Nó Sinusal/cirurgia
2.
Card Electrophysiol Clin ; 16(2): 133-138, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38749631

RESUMO

Persistent left superior vena cava (PLSVC) is an anatomic variant that is relatively uncommon in the general population. Lead extraction through PLSVC is extremely rare. Due to unusual anatomy, the procedure carries challenges that require special considerations and careful planning. The authors report a case of lead extraction through a PLSVC with occluded right superior vena cava and highlight the challenges and outcomes of the procedure.


Assuntos
Remoção de Dispositivo , Síndrome da Veia Cava Superior , Veia Cava Superior , Humanos , Veia Cava Superior/anormalidades , Veia Cava Superior/cirurgia , Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/cirurgia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior Esquerda Persistente/cirurgia , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Masculino , Desfibriladores Implantáveis , Marca-Passo Artificial , Feminino
3.
Eur J Radiol ; 175: 111446, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38581861

RESUMO

PURPOSE: To investigate the safety and efficacy of large-bore uncovered stents for treating malignant superior vena cava syndrome. METHODS: This retrospective study included 115 patients (89 men, 26 women; mean age 63.2 years; range 21-83 years) who underwent endovascular large-bore (≥18 mm in diameter) uncovered stent placement between August 2015 and July 2022. One patient was lost to follow-up. Therefore, 114 patients were available for follow-up. RESULTS: Stent placement was technically successful in all 115 patients. Minor procedure-related complications occurred in nine (7.8 %) patients. One hundred eight (93.9 %) patients experienced complete or marked symptomatic relief (Kishi score ≤ 2) at a mean of 3 days after procedure. The cumulative stent patency rates were 98.2 %, 95 %, 93.7 %, 91.5 %, 83.5 %, and 83.5 % at 1, 3, 6, 12, 18, and 24 months, respectively. Stent occlusion occurred in ten (8.8 %) of 114 patients at a mean of 215 days (range 1-732 days) due to thrombosis (n = 7) and tumor ingrowth (n = 3). Stent occlusion did not occur in 21 patients who underwent subsequent central venous catheter insertion. The median patient survival time was 159 days (95 % confidence interval 102-216 days). Univariate and multivariate Cox regression analysis revealed adjuvant anticancer treatment (p = 0.001) and tumor response (p < 0.001) as independent predictors of patient survival. CONCLUSIONS: Endovascular placement of large-bore uncovered stents was a safe and effective treatment for malignant superior vena cava syndrome. Large-bore stent placement can effectively prevent stent occlusion by tumor ingrowth in most cases, and it can provide a sufficient diameter for subsequent insertion of central venous catheters.


Assuntos
Stents , Síndrome da Veia Cava Superior , Humanos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/cirurgia , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/terapia , Masculino , Pessoa de Meia-Idade , Feminino , Idoso , Adulto , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Resultado do Tratamento , Adulto Jovem , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos
4.
J Cardiothorac Surg ; 19(1): 151, 2024 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-38521937

RESUMO

BACKGROUND: Iatrogenic complications of endovascular treatment for central venous stenosis have not yet been reported. Here we present a case of a patient on maintenance hemodialysis who developed catheter-related superior vena cava syndrome and subsequently suffered from hemorrhagic pericardial tamponade after undergoing percutaneous transluminal angioplasty and stenting. CASE PRESENTATION: A 72-year-old male patient presented with uremia, and had been receiving maintenance hemodialysis for the past five years. The patient initially presented with dysfunction of the dialysis catheter (a cuffed tunneled double-lumen catheter in the right internal jugular vein). Imaging examination revealed a segmental occlusion of the superior vena cava stretching from the distal end of the dialysis catheter up to right atrium entrance, apparent compensatory dilatation of the azygos vein, and abundant subcutaneous collaterals. The patient underwent percutaneous transluminal balloon dilatation and stenting (covered stent) of the superior vena cava in the Cath Lab. During the procedure, with forceful advancement of the guidewire, it was observed to progress for a distance before a "smoke" appeared, and an outward spillage of contrast agent was visible, which suggested a possible vessel puncture leading into the mediastinum. Unfortunately, postoperative hemorrhagic pericardial tamponade occurred and the patient developed cardiogenic shock. He experienced symptoms included chest tightness and breath shortness with a recorded blood pressure of 84/60mmHg. After draining 600 ml of bloody fluid through pericardiocentesis, the patient's symptoms alleviated and his condition improved. CONCLUSIONS: The case emphasizes the need for increased attention to iatrogenic endovascular injuries during catheter placement and endovascular treatment, such as causing pericardial hemorrhage leading to cardiac tamponade.


Assuntos
Tamponamento Cardíaco , Cateterismo Venoso Central , Derrame Pericárdico , Síndrome da Veia Cava Superior , Doenças Vasculares , Masculino , Humanos , Idoso , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Veia Cava Superior , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cateterismo Venoso Central/efeitos adversos , Diálise Renal/efeitos adversos , Catéteres/efeitos adversos , Doença Iatrogênica
5.
Thorac Cancer ; 15(7): 578-581, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38316628

RESUMO

Intraluminal tumor in the azygos vein is a rare disease that can cause superior vena cava (SVC) syndrome. Radiotherapy and endovascular stenting with or without chemotherapy are reported to have a high clinical success rate for the management of SVC syndrome with malignancy, but a poor survival rate. Here, we report a 69-year-old man who presented with swelling of the face and upper extremities, who was diagnosed with SVC syndrome caused by an intraluminal tumor in the azygos vein. Enhanced chest computed tomography revealed an intraluminal mass with a filling defect from the azygos vein to the SVC, with no extravascular extension or dissemination of the primary tumor. Surgical resection of the mass en bloc with the azygos vein and SVC reconstruction was performed. A poorly differentiated carcinoma was diagnosed on postoperative pathological evaluation. Twelve months after resection, the patient was well with no signs of recurrent disease. This case highlights that surgical resection should be considered as a treatment of choice for the management of SVC syndrome caused by an intraluminal malignancy in the azygos vein.


Assuntos
Neoplasias Primárias Desconhecidas , Síndrome da Veia Cava Superior , Masculino , Humanos , Idoso , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Síndrome da Veia Cava Superior/diagnóstico , Veia Ázigos/cirurgia , Veia Cava Superior/cirurgia , Neoplasias Primárias Desconhecidas/complicações , Tomografia Computadorizada por Raios X
11.
J Cardiovasc Surg (Torino) ; 63(6): 674-681, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36469045

RESUMO

Superior vena cava (SVC) syndrome refers to the clinical manifestations of cerebral venous hypertension secondary to obstruction of the SVC and/or the innominate veins. The most common cause of SVC syndrome is malignancy like small cell lung cancer and non-Hodgkin lymphoma, but there is an increasing trend of benign etiologies secondary to thrombosis due to central lines/ pacemakers or mediastinal fibrosis. Supportive measures include head elevation, diuresis, supplemental oxygen, and steroids. Thrombolysis with or without endovenous stenting is required emergently in those with airway compromise or symptoms secondary to cerebral edema. Definitive treatment in those with malignancy is multidisciplinary; this requires radiotherapy, chemotherapy, SVC stenting, oncologic surgery and SVC bypass or reconstruction. Endovascular treatment is the primary modality for palliation in malignancy and in those with benign etiology. Surgery is reserved for those who have failed or are unsuitable for endovascular treatment. In patients with benign disease endovenous stenting and open surgery provide excellent symptom relief and are safe and effective.


Assuntos
Mediastinite , Síndrome da Veia Cava Superior , Trombose , Humanos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Veia Cava Superior , Stents/efeitos adversos , Mediastinite/complicações
12.
J Card Surg ; 37(12): 5559-5563, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36349719

RESUMO

BACKGROUND AND AIM OF THE STUDY: Behcet's disease (BD) is a multisystem vasculitis with unknown etiology. The involvement of superior vena cava (SVC) is reported in less than 2% of patients with BD. METHODS: We report a patient with acute edema of neck and face associated with dyspnea as the primary manifestation. So a diagnosis of superior Vena Cava syndrome (SVCS) was made and the thickening wall of SVC was resected. An Operation was performed under cardiopulmonary bypass to remove the mass and thrombus for avoiding for pulmonary embolism. RESULTS: The diagnosis of Behcet's disease (BD) didn't not be made until the recurrent oral and genital ulceration occurred 2 weeks later. The patient taked aspirin and prednisolone orally as prescribed and no recurrence were observed during the 30 months follow-up. CONCLUSIONS: BD should be suspected in patients presenting with SVCS, when there is thickening of SVC, whether thrombosis or not. Early diagnosis and treatment are essential for management of BD.


Assuntos
Síndrome de Behçet , Embolia Pulmonar , Síndrome da Veia Cava Superior , Trombose , Humanos , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Veia Cava Superior , Síndrome de Behçet/complicações , Síndrome de Behçet/cirurgia , Trombose/cirurgia , Trombose/complicações , Embolia Pulmonar/complicações
13.
Nagoya J Med Sci ; 84(3): 648-655, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36237890

RESUMO

Superior vena cava (SVC) syndrome refers to a constellation of symptoms secondary to obstruction of blood flow through the SVC. In this condition, venous blood that usually drains into the SVC is diverted into the inferior vena cava (IVC) via collateral veins. Reconstructive surgery is challenging in such cases owing to the anomalous venous system. In this case report, we describe reconstructive surgery using a pedicled omental flap in a patient with upper thoracic empyema and concomitant SVC syndrome. A 68-year-old man underwent resection of malignant thymoma, the bilateral brachiocephalic veins, and a part of the right upper lobe, followed by polytetrafluoroethylene (PTFE) graft placement for venous system reconstruction, 2 years prior to presentation. He developed postoperative upper thoracic cavity empyema, which necessitated PTFE graft removal. Although the infection was controlled after 2 months, multiple right upper lobe pulmonary fistulas persisted, and the patient was referred to our department for further evaluation. Contrast-enhanced computed tomography revealed SVC syndrome characterized by SVC obstruction and consequent drainage of venous blood from the upper trunk into the IVC via collateral vessels. We debrided necrotic and infected tissues, and a pedicled omental flap was placed for upper lobe fistula coverage. The patient showed an uncomplicated postoperative course, and no recurrent empyema or pulmonary fistulas were observed 3 years postoperatively. Flaps associated with the SVC system show high venous pressures. The use of a pedicled omental flap was deemed feasible because this graft reaches the upper thorax even though it is associated with the IVC system.


Assuntos
Empiema Pleural , Procedimentos de Cirurgia Plástica , Síndrome da Veia Cava Superior , Idoso , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Humanos , Masculino , Politetrafluoretileno , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Veia Cava Superior/anormalidades , Veia Cava Superior/cirurgia
15.
Vasc Endovascular Surg ; 56(8): 817-819, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35961606

RESUMO

Reports documenting the mid-term patency of spiral saphenous vein grafts for superior vena cava syndrome in patients with advanced thoracic malignancy are, so far, scarce. The present report describes a 69-year-old man who suffered superior vena cava syndrome due to malignant invasion by advanced lung cancer. Since the huge mass in the anterior mediastinum was unresectable, a bypass from the left innominate vein to the right atrium using an autologous spiral saphenous vein graft was surgically created. Postoperatively, the patient received chemoradiotherapy and maintenance anticoagulant therapy, resulting in survival for 4 years without graft occlusion or recurrence of superior vena cava syndrome.


Assuntos
Síndrome da Veia Cava Superior , Doenças Vasculares , Idoso , Anticoagulantes , Humanos , Masculino , Veia Safena/transplante , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Resultado do Tratamento , Doenças Vasculares/cirurgia
16.
J Vasc Surg Venous Lymphat Disord ; 10(6): 1279-1287.e1, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35843595

RESUMO

OBJECTIVE: In the present study, we evaluated the technical and clinical outcomes of thoracic central vein reconstruction for superior vena cava (SVC) syndrome using kissing Viabahn VBX stent grafts (W.L. Gore & Associates, Flagstaff, AZ). METHODS: All adult patients with SVC syndrome who had undergone attempted bilateral brachiocephalic vein-to-SVC reconstruction using kissing VBX stent grafts at an academic hospital between August 2019 and February 2021 were reviewed. The technical results, adverse events, imaging follow-up findings, and clinical outcomes were recorded. Patency over time was assessed using Kaplan-Meier analysis. RESULTS: A total of 28 patients (16 women and 12 men; mean age, 52.0 years) constituted the study cohort. Of the 28 patients, 17 (60.7%) had had benign and 11 (39.3%) malignant etiologies. The presenting symptoms included neck swelling (n = 17; 60.7%), bilateral upper extremity swelling (n = 15; 53.6%), dyspnea (n = 7; 25%), unilateral upper extremity swelling (n = 4; 14.3%), and dysphagia (n = 1; 3.6%). SVC reconstruction with VBX stent grafts in a kissing configuration was successfully completed in 27 of the 28 patients (96.4%). Four major adverse events were noted in the benign etiology subgroup (23.5%), including intraprocedural hemopericardium (n = 3) and delayed pneumothorax (n = 1). Of the 28 patients, 27 (96.4%) had experienced resolution of their presenting symptoms. The mean clinical follow-up for the living patients was 358.8 ± 77.2 days (range, 78-645 days). The mean imaging follow-up for the living patients was 272.6 ± 91 days (range, 26-594 days). The primary, primary-assisted, and secondary patency rates at 12 months were 71.8%, 88.8%, and 100%, respectively. CONCLUSIONS: For the management of SVC syndrome, thoracic central vein reconstruction with kissing VBX stent grafts was feasible with a high rate of symptom resolution and acceptable patency. However, this technique should not be recommended for those with benign SVC syndrome owing to the high risk of cardiac tamponade.


Assuntos
Síndrome da Veia Cava Superior , Adulto , Veias Braquiocefálicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Resultado do Tratamento , Veia Cava Superior
17.
Cardiovasc Intervent Radiol ; 45(9): 1236-1254, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35821122

RESUMO

PURPOSE: Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). METHODS: MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper-Pearson estimation. RESULTS: Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0-97.5%) and 92.8% (95% CI 91.7-93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0-93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). CONCLUSIONS: This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. LEVEL OF EVIDENCE: Level III, systematic review of retrospective cohort studies.


Assuntos
Procedimentos Endovasculares , Stents , Síndrome da Veia Cava Superior , Adulto , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Humanos , Estudos Retrospectivos , Stents/efeitos adversos , Síndrome da Veia Cava Superior/cirurgia , Resultado do Tratamento
19.
Pacing Clin Electrophysiol ; 45(9): 1051-1055, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35579295

RESUMO

Superior vena cava (SVC) syndrome is a rare disease induced by thrombosis and consequent occlusion of SVC, negatively affecting morbidity and mortality. The incidence of SVC syndrome from central venous catheters and pacemaker or defibrillator leads is increasing. Optimal treatment of pacemaker or defibrillator-related SVC syndrome is not well defined. Lead extraction causes mechanical trauma to the vessel wall. In addition, subsequent device implantation on the contralateral side can be an added factor for venous occlusion. The use of leadless pacemakers could be an interesting option to reduce the risk of SVC restenosis after lead extraction. We report a clinical case of PM leads-related SVC syndrome referred to our centers and treated with transvenous lead extraction, leadless pacemaker implantation and subsequent percutaneous angioplasty and stenting of the SVC and left innominate vein.


Assuntos
Marca-Passo Artificial , Síndrome da Veia Cava Superior , Trombose , Humanos , Marca-Passo Artificial/efeitos adversos , Stents/efeitos adversos , Síndrome da Veia Cava Superior/cirurgia , Síndrome da Veia Cava Superior/terapia , Trombose/complicações , Veia Cava Superior
20.
Thorac Cancer ; 13(11): 1726-1730, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35445539

RESUMO

A 24-year-old male patient was admitted to our center complaining of dizziness (superior vena cava syndrome [SVCS]), dysphagia and pain in the right chest wall. At the initial diagnosis, the patient had been found to have an irregular shaped 35 × 30 × 27 cm mass in the right side of his chest. On November 12, 2019, this patient received surgery in our center. The right sixth rib and the tumor were completely removed (R0), while preserving all the lung tissue and other organs in the chest. The patient recovered well after surgery, and his right lung was fully expanded.


Assuntos
Transtornos de Deglutição , Sarcoma de Ewing , Síndrome da Veia Cava Superior , Adulto , Transtornos de Deglutição/etiologia , Humanos , Masculino , Costelas/patologia , Costelas/cirurgia , Sarcoma de Ewing/complicações , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/cirurgia , Síndrome da Veia Cava Superior/diagnóstico , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Adulto Jovem
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