Endovascular stenting is the standard of care for superior vena cava (SVC) obstruction, providing rapid symptom relief and high technical success rates. However, no guidelines exist for the concurrent use of centrally inserted central catheters (CICCs) within stents or for optimal antithrombotic strategies. We report a case of a 69-year-old woman with malignant Superior Vena Cava Syndrome (SVCS) treated with a central venous stent (CVS) placement who subsequently required a jugular CICC for antibiotic therapy. Six days later, she developed recurrent edema. Imaging revealed extensive thrombosis involving the stent and adjacent veins, while ultrasound demonstrated a prominent fibroblastic sleeve (fibrin sheath) at the catheter entry site. Despite thrombo-aspiration and catheter removal, the sleeve persisted, exhibiting the characteristic "ghost sign." Additional kissing stents restored partial patency, and anticoagulation was resumed.This case underscores the potential risks of placing a CICC within a previously inserted CVS. The coexistence of thrombosis and a fibroblastic sleeve on the same catheter-reported here for the first time-suggests that these entities, although distinct, can occur together. It is plausible that the flow reduction caused by the fibroblastic sleeve may increase the risk of thrombus formation, thereby raising the likelihood of stent thrombosis and recurrent SVCS. Imaging revealed that a fibroblastic sleeve, recognizable by the "ghost sign," persisted even after catheter removal, underscoring the diagnostic and therapeutic challenges of distinguishing it from thrombosis. Current guidelines do not address this situation, and data are limited. Until more evidence is available, clinicians should consider alternative access options-such as Femorally Inserted Central Catheters (FICCs)-when CVS are present and manage anticoagulation carefully. Multidisciplinary teamwork and regular follow-up are essential to improve outcomes and prevent recurrence.

Techniques and outcomes of recanalization and reconstruction for treatment of symptomatic venous ligation.

Internal Jugular Vein (IJV) compression is a common cause of cerebral venous hypertension symptoms such as headache and pulsatile tinnitus. Various causes are identified with cervical compression by the C1 transverse process being a rare one. Surgical styloidectomy and transverse process resection are commonly performed to relieve the pressure placed upon the IJV, however, minimally invasive treatments such as venous stenting are promising solutions. A 73-year-old patient presented to our outpatient clinic with peripheral vertigo, nystagmus, and gait instability. Computed tomography revealed stenosis of the left IJV caused by compression from the C1 transverse process. This rare anatomical variant was treated successfully with venous stenting, leading to significant symptomatic improvement. This case highlights the importance of considering extracranial venous stenosis as a differential diagnosis in patients with unexplained vertigo and demonstrates the utility of advanced endovascular techniques in managing such cases. This case illustrates that clinical presentation of venous hypertension could rarely be caused by extrinsic compression of jugular veins, either by vertebral transverse processes or styloid processes. Although generally treated surgically, we consider that minimally invasive endovascular venous stenting is a potentially effective treatment strategy. This is demonstrated by venous manometric pressure improvement and symptom resolution in the presented patient. This treatment approach deserves further research to demonstrate its clinical impact, recommendations, and long-term impact.

We report a case of a large distal arch and proximal descending thoracic aortic saccular aneurysm managed successfully with type I hybrid arch repair (off-pump debranching + thoracic endovascular aortic repair). Conventional open total arch replacement involves significant peri-operative risks, especially in elderly or comorbid patients, due to the need for cardiopulmonary bypass, circulatory arrest and cerebral protection. The hybrid arch repair technique combines open debranching of supra-aortic vessels with endovascular stent grafting to exclude the aneurysmal segment. This method avoids circulatory arrest, reduces operative time and minimizes complications, while maintaining the durability of open repair. It is particularly suitable for aneurysms of the distal arch and proximal descending thoracic aorta, with an adequate ascending aortic landing zone for endograft deployment.

Fibrosing mediastinitis (FM) is a rare benign disorder characterized by excessive fibrotic proliferation within the mediastinum. Due to its insidious onset and nonspecific clinical presentation, FM is often misdiagnosed or diagnosed at a late stage, leading to significant morbidity. Case reports detailing its long-term course and response to interventional management remain limited. This case is reported to highlight the diagnostic challenges in FM presenting with prolonged hemoptysis and to demonstrate the therapeutic potential of pulmonary vascular intervention in alleviating vascular compression and improving hemodynamics. A 56-year-old male patient presented with intermittent hemoptysis lasting over 5 years, which had worsened over the past week. Imaging studies, including contrast-enhanced chest computed tomography and pulmonary artery CTA, revealed calcified mediastinal lymph nodes in both hilar regions, right middle lobe atelectasis, and pulmonary artery branch stenosis with secondary pulmonary hypertension. A final diagnosis of fibrosing mediastinitis complicated by pulmonary hypertension and lobar collapse was established. Five years earlier, the patient underwent bronchoscopy and received cryotherapy and dilation for right middle lobe atelectasis, with no significant improvement observed. During the current admission, right heart catheterization and pulmonary angiography revealed multiple sites of extrinsic pulmonary artery stenosis, for which stents were implanted at the narrowed segments. Following the procedure, pulmonary artery pressure decreased significantly, clinical symptoms improved markedly, and no further episodes of hemoptysis were reported during follow-up. This case underscores the importance of considering FM in the differential diagnosis of chronic unexplained hemoptysis, particularly when accompanied by mediastinal calcification, lobar collapse, and pulmonary hypertension. Early use of pulmonary artery CTA can aid in timely diagnosis, and endovascular stent placement represents a effective minimally invasive treatment option for selected cases of FM-induced pulmonary artery stenosis.

A systemic review and meta-analysis of the endovascular management of carotid blowout syndrome.

IntroductionThe optimal extent of aortic arch intervention for acute type A aortic dissection (ATAAD) remains uncertain. Total arch replacement with a frozen elephant trunk (TAR + FET) prolongs circulatory-arrest time, whereas hybrid arch repair (HAR)-supra-aortic debranching in combination with antegrade endovascular stent grafting-reduces ischemic time but may increase the risk of late reintervention.ObjectiveThis study aims to compare mid-term survival and freedom from reintervention after HAR versus TAR in ATAAD.MethodsPubMed, Embase, and Scopus were searched from their inception to May 2025. Kaplan-Meier Curves were digitized, and individual-participant data were reconstructed with a validated algorithm. Pooled hazard ratios (HR) were derived from a one-stage flexible parametric model; robustness was assessed with two-stage random-effects meta-analysis, leave-one-out tests.ResultsFive propensity-matched studies (n = 697; 338 HAR, 359 TAR) met inclusion criteria. Hybrid arch repair shortened cardiopulmonary bypass and avoided circulatory arrest time. Five-year survival was 86.5% for HAR versus 76.2% for TAR (log-rank p < 0.001). Hybrid arch repair provided a significant early-to-mid-term survival advantage over TAR in ATAAD (HR 0.46 (95% CI 0.31-0.69; p < 0.001)), corresponding to about 6 months of survival benefit at 5 years. Hybrid arch repair was associated with greater likelihood of early reintervention (HR 4.07, 95% CI 0.55-30.34).ConclusionHybrid arch repair offers a significant early-to-mid-term survival advantage over TAR in ATAAD. In patients requiring aortic arch replacement, HAR may be favored over TAR/FET, while extensive TAR/FET procedures are reserved for anatomically unsuitable cases.

Endovascular repair of external iliac vein injury caused by acetabular screw penetration during total hip arthroplasty: a case report

Endovascular Stenting for Malignant Superior Vena Cava Syndrome Complicated by Interstitial Pneumonia: A Report of 2 Cases

Abstract Aim Coeliac artery (CA) or superior mesenteric artery (SMA) stenosis can preclude safe pancreaticoduodenectomy (PD) due to elimination of collateral blood supply mediated through the pancreaticoduodenal arcades. Optimisation of mesenteric blood flow is vital to reduce ischaemic complications. Treatment options include endovascular stenting and surgical approaches, such as median arcuate ligament release (MALR) or bypass. While intervention is practised in some pancreatic centres, there is yet to be a standardised approach within the United Kingdom. We describe our recent experience, spanning a 4-year period involving ten patients undergoing PD resection with CA or SMA intervention. Method Data was extracted from a prospectively kept department database, and an electronic patient record system was utilised to collect a detailed description of patient and disease factors, timing and technique of arterial stenting and standardised post-operative outcomes. Results Ten patients were identified as having a clinically significant CA or SMA stenosis. Three patients underwent MALR intra-operatively, three patients underwent CA stenting, and four patients underwent SMA stenting. Of these ten patients, two (20%) had a clinically relevant post-operative pancreatic fistula (cr-POPF). Adjusting for fistula risk scores, no significant difference was observed in POPF risk against actual POPF rate (p=0.927). One patient (10%) required re-operation for a gastro-jejunal anastomotic bleed, and two patients (20%) developed delayed gastric emptying (DGE). We experienced one mortality (10%) associated with prolonged DGE. Conclusions CA or SMA stenting can facilitate safe pancreaticoduodenectomy. Our patient cohort did not appear to be associated with an increased risk of POPF, or other routine complications experienced during PD.

Pulmonary vein stenosis (PVS) is an uncommon but serious complication of atrial fibrillation (AF) ablation, often misinterpreted as primary pulmonary disease. Timely identification is essential to prevent irreversible injury and to guide appropriate referral for interventional management. Through the discussion of two practical case examples, we illustrate the challenges of early recognition, the role of imaging modalities, and the decision-making process in selecting the most effective interventional strategy. Both young male patients developed progressive dyspnoea, chronic cough, and recurrent pneumonia months after AF ablation and were initially managed for presumed pulmonary pathology. Multimodal imaging-including CT, transoesophageal echocardiography, and selective angiography-confirmed severe multivessel PVS, with a true bifurcation lesion in one case. The patients were referred for transcatheter pulmonary angioplasty. Procedures were performed under combined fluoroscopic and echocardiographic guidance. In Patient 1, after stenting of the left middle lobar vein in crossover with the left superior pulmonary vein (provisional approach), residual ostial stenosis of the left superior vein required escalation to a culotte bifurcation strategy. Remaining lesions in both patients were treated with large-diameter stents. Early recognition using echocardiography and CT angiography is crucial. Endovascular interventions-particularly stent implantation-provide effective restoration of venous flow, but standardized protocols, long-term patency assessment, and optimal antithrombotic therapy remain areas of ongoing investigation. Advances in coronary intervention may guide refined techniques for managing complex PVS. This paper presents a comprehensive clinical management approach, from symptom onset to definitive treatment.

ObjectivesSymptomatic stenosis of the extracranial vertebral artery is an important cause of posterior circulation stroke. Endovascular stenting has shown promise for these lesions, but evidence in patients aged ≥ 70 years is limited. This study assessed perioperative safety and intermediate-term efficacy of extracranial vertebral artery stenting in elderly patients (≥70 years) by comparing rates of complications, restenosis, stroke, and death with those in younger patients.MethodsWe retrospectively analyzed patients with symptomatic extracranial vertebral artery stenosis (VAS) treated at our center from 2019 to 2024. Patients were divided into two groups (≥70 vs. <70 years). All patients had failed medical therapy (antiplatelet ± statin) and underwent stent placement. We compared perioperative adverse events, in-stent restenosis (ISR), target-vessel stroke, and any stroke or death between groups.ResultsAmong 224 patients (93 aged ≥ 70, 131 aged < 70), technical success was 100%. Median age was 74 (IQR 72–77) in the ≥70 group and 63 (IQR 59–66) in the <70 group. Perioperative complication rates did not differ significantly (4.3% vs. 3.1%; p = 0.721). Over a mean follow-up of 15 months, ISR occurred in 13.5% of ≥70 patients and 17.6% of <70 patients (p = 0.50), and target-vessel stroke occurred in 3.3% vs. 1.6% (p > 0.05). Multivariate analysis showed that bare-metal stent use and hyperuricemia independently predicted ISR. However, the combined outcome of any stroke or death was significantly higher in the ≥70 group than in the <70 group (14.6% vs. 3.2%, log-rank p < 0.05), which was largely attributed to more severe atherosclerosis and a higher burden of comorbidities in the older population.ConclusionIn symptomatic patients with extracranial VAS, endovascular stenting in the elderly (≥70 years) appears comparably safe to younger patients, with similarly low restenosis and target-stroke rates. Use of bare-metal stents and hyperuricemia were associated with higher ISR. These findings support considering vertebral stenting in elderly patients, but emphasize the need for close follow-up.

Highlight: This study describes profiles of patients who received endovascular stenting services A descriptive method study was selected to offer a thorough overview ABSTRACT Introduction: Endovascular stenting (ES) is an alternative therapy to carotid endarterectomy (CEA) and best management therapy (BMT) for intracranial and extracranial arterial stenosis with or without symptoms. Atherosclerosis can cause non-hemorrhagic stroke, and the risk factors include diabetes mellitus, dyslipidemia, smoking, hypertension, and advanced age. Objective: This study aimed to determine the profile of non-hemorrhagic stroke patients who received ES services at Dr. Kariadi General Hospital, Semarang. Method: This research used a descriptive method with sampling carried out sequentially using electronic patient medical record data from January 2023 to November 2024. Result: ES services were obtained for 67 patients, of whom 39 were men (58.2%). The largest age groups were between &gt; 50-60 years and &gt; 60-70 years, accounting for 37.3%. The stenosis in the proximal vertebral artery was performed by ES in 70.1% patients. ES was performed on 62.7% patients, with an average stenosis degree of 59.8% in the 50%–69% range (moderate to severe stenosis group). Risk factors for atherosclerosis in this study included hypertension in 67.2% patients and dyslipidemia in 52.2%. There were 71.6% of patients who did not have risk factors for diabetes mellitus. In this study, only 2 patients’ data from medical records were examined for smoking risk factors. Conclusion: Non-hemorrhagic stroke patients who received endovascular stenting services at Dr. Kariadi General Hospital, Semarang, were men in their 50s and 60s, with lesions in the proximal vertebral artery with an average stenosis degree of 59.8%. Risk factors included hypertension, age, and dyslipidemia.

Highlight: CVSS is an underdiagnosed but reversible cause of chronic headache Venous stenting effectively restores venous outflow and reduces ICP Early recognition and intervention lead to rapid and sustained symptoms resolution ABSTRACT Introduction: Chronic headache poses a significant diagnostic and therapeutic challenge. Cerebral venous sinus stenosis (CVSS) is an underrecognized yet important etiology in which stenosis impairs venous outflow and elevates intracranial pressure, leading to headache. Endovascular stenting offers a therapeutic approach by mechanically restoring venous flow. Case: A 43-year-old female presented with a chronic headache for 3 months, refractory to multimodal medical therapy. Digital subtraction angiography (DSA) confirmed stenosis in the bilateral transverse sinuses. The patient subsequently underwent successful endovascular venous stenting. Conclusion: This case underscores that CVSS is a potentially treatable cause of chronic headache. Endovascular intervention can provide rapid symptomatic relief for patients with medically refractory headache secondary to venous sinus stenosis. Long-term follow-up remains essential to confirm sustained benefit.

Complex Outflow Graft Thrombosis of a Patient on Durable Left Ventricular Assist Device: An Interventional Treatment Strategy.

Stent It and Forget It? Not in Kids: Endovascular Treatment of Traumatic Arterial Injuries in Adolescents.

ABSTRACTTakayasu arteritis (TAK) is a rare large‐vessel vasculitis affecting the aorta and its major branches. Although autoimmune mechanisms are central, prior mycobacterial infections have been hypothesized to contribute to the disease onset. A 55‐year‐old South Asian woman with a history of vitiligo and treated multibacillary leprosy presented with right upper limb claudication and absent radial pulse. Angiography demonstrated thickening and narrowing of the right subclavian artery. Based on the 2022 ACR/EULAR classification criteria, TAK was diagnosed with a cumulative score of eight. Initial immunotherapy with intravenous prednisolone and methotrexate, followed by oral leflunomide, failed to achieve clinical improvement, following which endovascular stenting was planned. This case emphasizes the potential role of prior mycobacterial infections in TAK pathogenesis and highlights the need for early recognition, comprehensive vascular imaging, and individualized management in atypical or postinfectious presentations.

Five-Year Outcome of Provisional Extension to Induce Complete Attachment Aortic Repair for Chronic Residual Aortic Dissection DeBakey Type I.

Background: Superior vena cava syndrome (SVCS) is most commonly caused by malignant obstruction, particularly lung cancer. Early recognition and accurate staging are essential to guide therapeutic decisions. Case-presentation: We report the case of a 49-year-old woman who presented with respiratory symptoms and was found to have a large right hilar–apical mass. Contrast-enhanced CT demonstrated invasion of the superior vena cava, right atrium, pulmonary artery, bronchus, mediastinal and retroperitoneal lymph nodes, and bone metastases. Initial classification as T3N2M0 was revised to stage IVB (M1c) following oncologic review. The patient developed progressive facial edema and venous congestion, consistent with malignant SVCS. She received anticoagulation, palliative radiotherapy and systemic therapy. Endovascular stenting was not performed due to extensive vascular invasion and disseminated disease. Discussion: This case illustrates the aggressive course of squamous cell lung carcinoma and highlights the pivotal role of contrast-enhanced CT in defining extent, determining unresectability and guiding treatment. Although endovascular stenting provides rapid symptom relief, its feasibility may be limited in advanced mediastinal invasion. Conclusion: Early recognition of malignant SVCS and prompt imaging are essential to optimize multidisciplinary management. In metastatic disease, treatment goals focus on palliation and quality of life.

BackgroundUncommon clinical manifestations of cerebral venous congestion syndrome (CVCS) are challenging for clinicians and may result in inappropriate treatment selection and incomplete clinical resolution. Although trigeminal neuralgia (TN) has been reported in association with CVCS, evidence of symptom resolution following venous sinus stenting (VSS) is lacking. We report a case in which VSS effectively alleviated TN.Case PresentationA middle-aged female patient presented with bilateral pulsatile tinnitus, papilledema, pressure headaches, as well as left-sided TN. Initial computerized tomography venography demonstrated bilateral transverse sinus stenosis and a prominent left mastoid emissary vein. Therefore, VSS was offered. Venous pressure measurements for extra- and intracranial veins were acquired, revealing a pressure gradient. Successful bilateral transverse sinus stenting was performed, resulting in a reduction of the pressure gradient in both sinuses. Endovascular stenting proved effective in managing CVCS symptomatology, including CVCS-induced TN. Residual left-sided pulsatile tinnitus due to the left mastoid emissary vein persisted.ConclusionThis case underscores the role of intracranial VSS in managing CVCS-associated symptoms, demonstrating its potential to relieve both typical and less common manifestations, including TN.