A case report of sharp recanalization in a hemodialysis patient with severe occlusion of both superior and inferior vena cave

Abstract

We present the case of a 53-year-old woman with a history of maintenance hemodialysis through arteriovenous fistula, CUFF catheter (cuffed tunneled catheter) and artificial vascular graft successively. Some signs of superior vena cava syndrome have presented including chronic edema in the face and left arm and varicose veins. Both CT (computed tomography) and angiography showed narrowing and occlusion in multiple veins, especially the right innominate vein, superior vena cava, inferior vena cava, left jugular vein, and bilateral common iliac veins. The first attempt at recanalization of the AVG (arteriovenous graft) failed due to severe occlusion of central venous. Finally, the patient was treated with a minimally invasive surgical approach involving percutaneous direct superior vena cava puncture driven by a single bend and vascular snare that were placed in the right atrium via hepatic vein percutaneous direct puncture under a double C arm angiographic device. The initial attempt failed with RUPS 100 (Cook, Chicago, USA) and was complicated by pericardial tamponade. The second attempt succeeded and the catheter was placed without hindrance and edema or varicose veins and its patency has remained for over 18 months following the intervention. It is the first successful case of sharp recanalization in combined superior and inferior vena cava syndromes with long-segment occlusion. This creative approach to providing vascular access offers a novel way to address refractory lesions in central veins.