AngioJetTM rheolytic thrombectomy with covered balloon-expandable stent deployment in a superior vena cava syndrome: a case report

Abstract

The Superior Vena Cava Syndrome (SVCS) is a rare mediastinal syndrome, frequently due to compression by a mediastinal malignant leading to venous flow obstruction through the Superior Vena Cava (SVC) towards the heart. The symptoms may consist of edema of the upper body and distended veins, dyspnea up to a life-threatening condition. Restoring the SVC flow by endovascular means can be beneficial in order to achieve a rapid relief of the clinical symptoms. A 51-year-old male with a recent diagnosis of squamous cell lung tumor diagnosis presented to the emergency department with persistent cough, neck and face swelling, and distended jugular veins on clinical examination. No dyspnea and normal vital parameters were reported. Computed Tomography angiography (CT) examination demonstrated thrombosis of subclavian veins and SVC due to compression by malignancy. Compression also involved the right upper lobar bronchus. Through a percutaneous transvenous right humeral access, phlebography confirmed total occlusion of the right subclavian vein, brachiocephalic venous trunk, and superior vena cava. We performed AngioJetTM (Boston Scientific, Marlborough, MA, USA) rheolytic endovascular thrombectomy. The phlebography demonstrated the unlying hemodynamic stenosis due to the ab-extrinsic compression and underwent stenting with a covered balloon-expandable stent. The final phlebography confirmed the patency of the stent and restoration of venous flow. Although there was a complete recovery of the symptoms, the patient died from respiratory complications caused by malignancy involvement. AngioJetTM mechanical thrombectomy and covered balloon-expandable stent deployment is a useful solution for SVCS to quickly achieve relief of the clinical symptoms. There are few case series where thrombectomy and primary stent placement are studied. Further follow-up studies are needed to understand the patency of treated vessels better.