Occlusion Of Superior Vena Cava Research Articles

Successful management of fatal cardiac tamponade resulting from intravascular intervention for central vein occlusion in hemodialysis patients: A case report.

This case report highlights the successful management of fatal cardiac tamponade caused by intravascular intervention for central vein occlusion in hemodialysis patients. Prompt diagnosis and treatment are essential for patient prognosis in such cases. We present a case involving a challenging surgical procedure to address multiple complications, emphasizing the importance of early detection and appropriate interventions. The patient, who had a history of long-term central venous catheter use for hemodialysis, was diagnosed with central vein stenosis in addition to superior vena cava occlusion, hemodialysis catheter rupture, hypertension, and end-stage renal disease. Urgent ultrasound examination during surgery revealed pericardial effusion, prompting immediate pericardial drainage for stabilization. To overcome the complex challenges, we successfully performed an innominate vein-right atrial appendage bypass to restore vascular access and salvage the patient's life. The timely use of echocardiography for diagnosis and pericardial drainage contributed to stabilizing the patient's vital signs, providing an opportunity for subsequent surgical intervention. The innominate vein-right atrial appendage bypass procedure successfully relieved central vein stenosis and saved the patient's life. Although this surgical technique is not widely documented in hemodialysis patients with central venous involvement, it show cases the potential benefits for clinicians managing vascular access in this patient population. This case report underscores the need for awareness among clinicians regarding the risk of cardiac tamponade associated with intravascular intervention for central vein stenosis in hemodialysis patients. Minimizing central venous catheterization and prioritizing autogenous arteriovenous fistulas are crucial principles in preparing vascular access for hemodialysis patients. Early detection, timely interventions, and consideration of alternative surgical techniques can improve outcomes and prevent life-threatening complications.

Procedural Insights and Clinical Outcomes of a Novel Superior Vena Cava Occlusion Device for Acute Heart Failure: A Single-Center Experience.

The preCARDIA system is a device combining a balloon-mounted catheter and an extracorporeal system designed for intermittent occlusion of the superior vena cava. Studies have established safety and efficacy in acute decompensated heart failure. We present a single-center experience detailing 90 days outcomes and procedural insights. A 24 hours therapy session demonstrated reduced pulmonary wedge pressures and increased urine output, with cardiac output remaining unchanged. There was one readmission and no heart failure-related readmissions at 90 days. The preCARDIA device appears to be a safe mechanical diuretic strategy to manage patients with acute decompensated heart failure beyond current therapeutic strategies.

Unraveling Intravascular Lobular Capillary Hemangioma: A Comprehensive Scoping Review.

This scoping review focuses on intravascular lobular capillary hemangioma (ILCH), a rare and distinct subset of lobular capillary hemangioma (LCH). This study provides a comprehensive overview of ILCH, delving into its clinical characteristics, origins, pathogenesis, diagnostic methods, treatment options, and outcomes. Despite its rarity, ILCH presents unique diagnostic and management challenges due to its intravascular origin. The review emphasizes the importance of accurate differentiation from other vascular lesions and underscores the need for histopathological confirmation. This article discusses the presentation of ILCH in the reported literature. The pathogenesis remains uncertain, with factors such as trauma, inflammation, hormonal changes, and medications being considered potential contributors. Histopathological features, imaging techniques, and diagnostic tools are discussed, highlighting the distinct histological architecture of ILCHs and the importance of immunohistochemical staining for accurate diagnosis. Surgical excision is the primary approach for managing ILCH due to its potential complications, including superior vena cava (SVC) occlusion and thrombosis. This review concludes by outlining potential directions for future research, including investigating genetic and molecular mechanisms underlying ILCH development, developing targeted therapies, building patient registries for collaborative efforts, and exploring minimally invasive surgical techniques. The importance of long-term patient outcome studies and international collaborations is emphasized to enhance our understanding of this rare vascular anomaly.

Rocket-shape crossing technique: A combination of lead extraction and modified venoplasty for device upgrade with venous occlusion.

This case discusses an upgrade method to cardiac resynchronization therapy defibrillator for a 54 year old man with superior vena cava occlusion. Right ventricular lead extraction with modified venoplasty, Rocket shape Crossing Technique (RCT), was performed. In RCT the integration of the inflated balloon, halfway inside the laser sheath, and the laser sheath are advanced through the occlusion like a rocket shape crossing.

Abstract 13972: Intermittent Occlusion of the Superior Vena Cava Improves Urine Sodium Excretion in Patients With Acutely Decompensated Heart Failure

BACKGROUND: Urine sodium excretion identifies risk for short and long-term adverse events in acutely decompensated heart failure (ADHF). The VENUS HF Early Feasibility Study is testing whether intermittent occlusion of the superior vena cava (SVC) with the preCARDIA system, a catheter mounted balloon and pump console, improves decongestion in ADHF. We hypothesized that preCARDIA therapy increases natriuresis in ADHF. Methods: In a multicenter, prospective, single-arm exploratory safety and feasibility trial, 32 patients with ADHF were assigned to preCARDIA therapy for 24 hours. Urine output and urine electrolytes were measured from a spot urine sample before, immediately after, and for 24 hours after preCARDIA treatment in 13 patients. Results: 32 patients were enrolled and received the preCARDIA system. Thirteen patients had complete urine electrolytes available for analysis. Compared to pre-treatment values, total daily urine output increased (1.9±0.8 vs. 4.2±1.5 L/day, p<0.001) and net fluid balance improved (-1.2±0.8 vs. -2.6±1.4 L/day, p=0.01) with treatment. Compared to pre-treatment, urine sodium (U-Na: 64±26 vs 97±24 mEq/L, p=0.0008) and U-Na/urine creatinine (U-Na/U-Cr: 1.7±1.3 vs 5.3±3.9 mmol/mg p=0.024) increased with treatment (Figure). Improved daily urine output and net fluid balance persisted 24 hours after treatment (1.9±0.8 vs 4.4±1.5 L p=0.0001; -1.2±0.8 vs -3.2±1.5 L/24h p=0.0003, respectively). Both U-Na and U-Na/U-Cr remained increased 24 hours after device removal (90 mEq/L, p=0.01; 3.93±2.8 p=0.026). Treatment increased fractional excretion of U-Na (2.08±1.87% vs. 4.22±2.72% p=0.05). No change in potassium excretion was observed. Conclusions: We report for the first time that intermittent SVC occlusion using the preCARDIA system to reduce congestion may increase urinary sodium excretion in ADHF. Future studies will further test the clinical utility of the preCARDIA system.

Abstract 14026: Intermittent Occlusion of the Superior Vena Cava Reduces Estimated Stressed Blood Volume in Patients With Acutely Decompensated Heart Failure

BACKGROUND: Stressed blood volume (SBV) refers to intravascular volume that produces hydrostatic pressure and contributes to congestion in acutely decompensated heart failure (ADHF). The VENUS HF Early Feasibility Study (EFS) is the first clinical trial testing intermittent occlusion of the superior vena cava (SVC) with the preCARDIA system, a catheter mounted balloon and pump console, to improve decongestion in ADHF. We hypothesized that preCARDIA therapy reduces SBV in ADHF. Methods: In a multicenter, prospective, single-arm exploratory safety and feasibility trial, 32 patients with ADHF were assigned to preCARDIA therapy for 24 hours. Invasive hemodynamics were measured before, immediately after, and for 3 hours after preCARDIA treatment. SBV was estimated (eSBV) using the hemodynamic simulator, Harvi, with heart rate (HR), cardiac output (CO), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), systolic and diastolic systemic arterial and pulmonary artery (PA) pressures, and left ventricular ejection fraction (LVEF) from 27 enrolled subjects. Results: Mean LVEF was 28±13%. Freedom from device or procedure related major adverse events was observed in 96% (n=26/27) of patients. Compared to pre-treatment values, CVP, PCWP, and PA pressures were significantly reduced, while systemic mean arterial pressures, HR and CO remained unchanged (Table 1). Daily urine output (2.6±1.9 vs 5.2±3.8 L, p=0.0072) and net fluid balance (-1.7±1.4 vs -3.4±2.6 L/24hr, p=0.0098) improved with 24-hours of treatment. Compared to pre-treatment values, eSBV decreased by 22% or -709±551 mL/70kg from baseline to 3 hours after treatment completion (3217±426 vs 2507±694 mL/70kg, p<0.000001). Conclusions: We report for the first time that intermittent SVC occlusion using the preCARDIA system reduced estimated stressed blood volume in patients with ADHF. These results support future studies characterizing the clinical utility of the preCARDIA system.

SUPERIOR VENA CAVA SYNDROME DUE TO A MEDIASTINAL MASS WITH RIGHT ATRIAL INVOLVEMENT

SUPERIOR VENA CAVA SYNDROME DUE TO A MEDIASTINAL MASS WITH RIGHT ATRIAL INVOLVEMENT

P7.06: Endovascular Thrombectomy in a Chronic Upper Cava Syndrome Due to Long Term Home Parenteral Nutrition. New Hope to Extend Life Support

Introduction: Chronic Intestinal Pseudo Obstruction(CIPO) refers to a heterogeneous group of disorders characterized by symptoms of intestinal obstruction, without evidence of mechanical lesion and is a cause of chronic intestinal failure. Loss of vascular accesses by thrombosis has become the current main indication for intestinal transplant. Materials and Methods: A 28-year-old female patient with a history of myopathic CIPO received Home Parenteral Nutrition(HPN) for 25 years, developing central venous accesses thrombosis. As a consequence of a chronic upper cava syndrome with occlusion of the right jugular and subclavian-axillary vein, an invalidating headache and inability to maintain dorsal decubitus due to retroocular pain evolves overtime, but worsen with HPN infusion, limiting the volume and calories provided. A multidisciplinary case discussion concluded that although chronic, an endovascular thrombectomy should be attempted to improve quality of life and to satisfy nutritional needs. Results: A vascular computer tomography(CT) scan with 3D reconstruction and a digital venography were performed showing complete occlusion of the right jugular, axillary and subclavian(where a picc-line was placed as last access) veins and a partial occlusion of the proximal superior vena cava(SVC) and occlusion of the right iliac vein. An angioplasty trough the right humeral, axillary, innominate trunk axis and superior vena cava using 6 & 9mm balloons was performed. Balloon dilatation of multiple venous strictures was done, followed by placement of two stents, one into the right subclavian vein and SVC, and the other into left subclavian vein, with restitution of venous blood flow. Anticoagulation with Rivaroxaban and Clopidrogel was started. On the 5th postoperative day a new onset of acute pain, paresthesia were reported, followed by edema in the right upper limb. A Doppler ultrasound was positive for an acute thrombosis, confirmed by CT scan. A new phlebography and mechanical thrombectomy using the ASPIREX device followed by a new angioplasty of a partial distal stenosis was done. A new stent implantation into humeral, axillary, and subclavian veins was performed. Outcome was favorable with complete resolution of the symptoms; being discharged on day 6. The patient currently is asymptomatic, receiving HPN without complications. Conclusion: This case is an example of the management of deep venous thrombosis secondary to the chronic use of HPN. A comprehensive multidisciplinary approach is mandatory due to its complexity, requiring to be performed by trained and expert interventionists, to successfully provide new alternatives to extend the possibility for their life support or avoid contraindications to transplant. Peripheral venous hemodynamic is not a common procedure however, is the cornerstone to treat this complication achieving in many cases the recovery of venous blood flow delaying the need of intestinal transplantation.

PO-717-02 TRANS-HEPATIC ‘BODY-FLOSSING’ TO OBTAIN ACCESS IN A PATIENT WITH VENOUS OCCLUSIONS FOR SUPRAVENTRICULAR TACHYCARDIA ABLATION

Trans-hepatic access (THA) can be performed for ablations in patients with femoral venous occlusions. In the setting of additional superior vena cava (SVC) occlusion, obtaining a second access can be challenging. To describe retrograde crossing of a chronic total venous occlusion (CTVO) followed by superior snaring after THA. n/a A 45-year-old female with a history of end-stage renal disease presented with recurrent supraventricular tachycardia refractory to medications. She had dialysis performed at different times via all 4 extremities and had known inferior CTVO. THA was obtained to gain access into the heart (A, blue arrows). Right internal jugular vein (IJV) was occluded; the left IJV vein was accessed, however, there was evidence of SVC stenosis (B, yellow dotted line), and a wire could not be advanced antegradely. Using a Glidewire from the THA, the stenosis was crossed retrogradely (C, yellow arrows). From the left IJV sheath, the wire tip was snared (D, white arrow), and pulled out (Figure 1E, green arrows). Once through-and-through access was obtained, a long sheath was advanced over the wire into the right atrium (F, red arrows) through which another decapolar catheter (G-H, orange arrow) was placed and with the help of the THA decapolar coronary sinus catheter (G, asterisk), the diagnosis of typical atrioventricular node reentrant tachycardia was confirmed. Following this, the THA decapolar catheter was replaced by an ablation catheter (H, red arrow) for successful slow pathway modification. Obtaining venous access in addition to the THA can be challenging in patients with superior and inferior venous stenosis. Retrograde crossing of CTVO scan be performed after THA, and with the help of snaring, additional access can be obtained.

Intermittent Occlusion of the Superior Vena Cava to Improve Hemodynamics in Patients With Acutely Decompensated Heart Failure: The VENUS-HF Early Feasibility Study.

Reducing congestion remains a primary target of therapy for acutely decompensated heart failure. The VENUS-HF EFS (VENUS-Heart Failure Early Feasibility Study) is the first clinical trial testing intermittent occlusion of the superior vena cava with the preCARDIA system, a catheter mounted balloon and pump console, to improve decongestion in acutely decompensated heart failure. In a multicenter, prospective, single-arm exploratory safety and feasibility trial, 30 patients with acutely decompensated heart failure were assigned to preCARDIA therapy for 12 or 24 hours. The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events through 30 days. Secondary end points included technical success defined as successful preCARDIA placement, treatment, and removal and reduction in right atrial and pulmonary capillary wedge pressure. Other efficacy measures included urine output and patient-reported symptoms. Thirty patients were enrolled and assigned to receive the preCARDIA system. Freedom from device- or procedure-related major adverse events was observed in 100% (n=30/30) of patients. The system was successfully placed, activated and removed after 12 (n=6) or 24 hours (n=23) in 97% (n=29/30) of patients. Compared with baseline values, right atrial pressure decreased by 34% (17±4 versus 11±5 mm Hg, P<0.001) and pulmonary capillary wedge pressure decreased by 27% (31±8 versus 22±9 mm Hg, P<0.001). Compared with pretreatment values, urine output and net fluid balance increased by 130% and 156%, respectively, with up to 24 hours of treatment (P<0.01). We report the first-in-human experience of intermittent superior vena cava occlusion using the preCARDIA system to reduce congestion in acutely decompensated heart failure. PreCARDIA treatment for up to 24 hours was well tolerated without device- or procedure-related serious or major adverse events and associated with reduced filling pressures and increased urine output. These results support future studies characterizing the clinical utility of the preCARDIA system. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03836079.

Malignant Superior Vena Cava Syndrome: State of the Art.

Superior vena cava syndrome (SVCS) is a clinical entity characterized by signs and symptoms arising from the obstruction or occlusion of the thin-walled superior vena cava (SVC) and can result in significant morbidity and mortality. Despite the rise of benign cases of SVCS, as a thrombotic complication of intravascular devices, it is most commonly seen secondary to malignancy as a consequence of thrombosis, direct invasion of tumor cells inside the vessel, or external compression. SVCS can be the initial presentation of a previously undiagnosed tumor in up to 60% of cases. Lung cancer and non-Hodgkin lymphoma (NHL) are responsible for up to 85%-90% of malignancy-related SVCS, while metastatic cancers account for approximately 10%. Herein, we review the pathophysiology, etiology, clinical presentation, diagnosis, and management of malignancy-related SVCS.

Transvenous lead implantation via the accessory hemiazygos vein in superior vena cava occlusion.

Occlusion of the superior vena cava (SVCO) hinders pacemaker and defibrillator lead delivery. Central venous stenosis or occlusion due to pacemaker or defibrillator leads is relatively common at the time of lead revision or device upgrade; however, complete occlusion occurs in less than 10%.1,2 Multiple implanted leads is associated with increased risk of developing SVCO.3 The presence of a persistent left superior vena cava (SVC) also complicates lead delivery and impacts lead stability; however, lead delivery is often still feasible.

Re-appropriation of a right anterior thoracotomy approach to portal-systemic bypass for liver transplantation in a patient with complete superior vena cava occlusion

The utilization of venovenous bypass in liver transplantation (LT) has become less frequent and more center dependent over time. Unfortunately, this has left many transplant surgeons, particularly younger trainees, unfamiliar with the techniques and indications for its utilization. We present a case of LT in a patient with complete superior vena cava (SVC) occlusion prohibiting direct vascular access. A multi-disciplinary approach involving interventional radiology, anesthesiology, cardiac surgery, and transplant surgery, was used to diagnose, evaluate, and develop an operative plan for successful LT. In doing so, a novel approach to portosystemic bypass was utilized involving a right mini-thoracotomy with direct cannulation of the right atrium to gain central venous access and optimize venous return during LT. As a center that does not routinely use venovenous bypass, this multidisciplinary approach was crucial identifying the need for a rarely used technique for vascular access and performance of a successful LT.

Totally Endoscopic Ventricular Septal Defect Closed: How to do it?

Objectives: To describe the procedure of totally endoscopic closure of ventricular septal defect (VSD) without robotic assistance. Methods: Totally endoscopic VSD closure was performed in 17 patiens (12 childrens and 5adults). The age was 8,5 year olds ( from 3 to 46), and the body weight was 31,2 kg (from 10 to 57). 16 patients were diagnosed with peri-membranous VSD and 1 infundibular VSD, in which 5 patients had right ventricular outflow tract stenosis. We used three 5mm-trocarts and one 12mm-trocart in the right chest. Using pperipheral cannulation for ccardiopulmonary bypass, superior vena caval occlusion, Chitwood aortic clamp, right atriotomy and closing VSD by totally endoscopy without a robotically assisted surgical system. Results: There were no postoperative complications and deaths. cardiopulmonary bypass time and Aortic clamping time were 120 mins and 70 mins respectively. The mean mechanical ventilation time was 1.5 hours. Patients was hospitalized for 5.4 days and could resume normal daily activitive after 1 week. Conclusions: Totally endoscopic closure of ventricular septal defect without robotic assistance is safe and feasible leaving only a small surgical scar with good aesthetics.

Paradoxical Cerebral Embolism Secondary to Superior Vena Cava Occlusion and Development of a Systemic Right-to-Left Shunt

AbstractParadoxical cerebral embolism, although rare, can be secondary to acquired causes such as superior vena cava (SVC) occlusion and development of a mediastinal right-to-left shunt. Such shunts allow undisturbed passage of thromboemboli to bypass the pulmonary circulation and enter the systemic circulation. This report presents a case of paradoxical cerebral embolism due to a right-to-left shunt originating from occlusion of the SVC. The etiology of the SVC occlusion stems from a prior central venous access line used for treatment of lymphoma. The patient underwent endovascular treatment with successful coil embolization of the mediastinal shunt.

Long Term Results of Bypass Graft to the Right Atrium in the Management of Superior Vena Cava Syndrome in Dialysis Patients

Superior vena cava (SVC) occlusion in dialysis patients is a serious complication that can cause SVC syndrome and vascular access dysfunction. While endovascular therapy has advanced to become the first line of treatment, open surgical treatment may still be needed occasionally. However, no long term outcome data has been previously reported. We performed a retrospective review of 5 dialysis patients treated with bypass graft to the right atrium from 2012 to 2014. Four patients had severe dysfunction of their upper arm dialysis access as well as superior vena cava syndrome, and one patient with a femoral tunneled dialysis catheter (TDC) had SVC occlusion. None of the patients were candidates for lower extremity access creation or peritoneal dialysis (PD). Three patients underwent a left brachiocephalic-right atrial bypass and 2 underwent a bypass from the cephalic fistula to the right atrium. All procedures were technically successful and maintained function of the arteriovenous fistulas or allowed creation of a new upper extremity dialysis graft. One-year secondary patency rate of the bypass was 100%. Longer follow up revealed that one patient died of leg sepsis and another one of a stroke within 14 months after the procedure. Another patient did well for 16 months when recurrent graft thrombosis occurred; and ultimately the graft failed after 31 months despite multiple interventions. Two patients maintained bypass graft patency during a follow up of 78 months; however, they underwent multiple endovascular interventions (23) and open vascular access procedures (4) to maintain hemodialysis function. Bypass grafts to the right atrium in dialysis patients with SVC occlusion are successful in maintaining function of already existing vascular access or new ones. Long term secondary patency can be achieved but requires strict follow up and a proactive endovascular strategy to treat lesions in the access and or the bypass graft.

Endovascular Vena Cavae Occlusion Technique in Minimally Invasive Tricuspid Valve Surgery in Patients With Previous Cardiac Surgery

The aim of the present study was to describe a bicaval endovascular occlusion technique in minimally invasive tricuspid valve (TV) surgery in patients with previous cardiac surgery. Case series. Single tertiary university center. The study comprised ten patients. Endovascular occlusion of vena cavae for minimally invasive TV redo surgery. Between 2008 and 2017, ten patients with previous cardiac surgery underwent TV minimally invasive surgery (repair or replacement; isolated or with concomitant procedures) using the Coda balloon catheter (Cook Medical, Bloomington, IN) to occlude both vena cavae. Data were collected retrospectively from electronic medical records. Superior and inferior vena cava occlusion with Coda balloon catheters was successful with no complications. The drainage of the vena cavae was optimal with excellent surgical exposure. Cardiopulmonary bypass time was 131 ± 119 minutes, with 30% of patients undergoing aortic clamping (two with a Chitwood clamp, one with an endoaortic balloon). Intensive care unit length of stay was 3.9 ± 2.7 days, and the in-hospital mortality rate was 30%. Bicaval endovascular occlusion of vena cavae is a feasible and effective technique in patients with previous cardiac surgery who are undergoing a minimally invasive TV procedure. The high mortality rate is associated with the inherent risk of a redo surgery involving the TV.

Percutaneous management of superior vena cava syndrome in patients with cardiovascular implantable electronic devices

There is no consensus regarding the optimal management of cardiovascular implantable electronic device (CIED)-related superior vena cava (SVC) syndrome. We report our experience with transvenous lead extractions (TLEs) in the setting of symptomatic CIED-related SVC syndrome. We reviewed all TLEs performed at a high-volume center over a 14-year period and identified patients in which TLE was performed for symptomatic SVC syndrome. Patient characteristics, extraction details, percutaneous management of SVC occlusions, and clinical follow up data were analyzed. Over a 14-year period, more than 1600 TLEs were performed. Of these, 16 patients underwent TLE for symptomatic SVC syndrome. The mean age was 53.1 ± 12.8 years, and 9 (56.3%) were men. Thirty-seven leads, with a mean dwell time of 5.8 years (range 2-12 years), were extracted. After extraction, 6 patients (37.5%) received an SVC stent. Balloon angioplasty was performed before stenting in 5 cases (31.3%). There was 1 major complication (6.3%) due to an SVC tear that was managed surgically with a favorable outcome. Eleven patients underwent reimplantation of a CIED. Over a median follow-up of 5.5 years (interquartile range 2.0-8.5 years), 12 patients (75%) remained free of symptoms. Combining TLE with the percutaneous treatment of symptomatic SVC syndrome is a safe and viable treatment strategy.

Clinical importance and configuration of collateral vessel systems in patients with Takayasu arteritis or with thymoma visualized by three-dimensional volume rendering computed tomographic angiography

Abstract Background Collateral vessels form after gradual blood vessel occlusion. We speculate that in Takayasu arteritis (TA) and thymoma patients, before planning surgical procedures, a complex artery/venous system should be examined using three dimensional (3D) volume rendering computed tomographic (CT) angiography. Purpose To seek the clinical importance and actual complex configuration of collateral vessel systems in patients with TA or with thymoma using 3D volume rendering CT angiography with special acquisition method. Methods We performed 3D CT angiography in patients with Takayasu arteritis (TA) with occluded arteries (N=6) or thymoma (N=2) with occluded superior-vena-cava (SVC), respectively. For CT angiography in thymoma patients, diluted (1/4) iodinated-contrast was injected in right and left medial cubital-veins simultaneously, and images acquired 10 seconds after contrast-injection. Results Occluded and collateral-arteries (TA group) and occluded SVC and collateral-veins (thymoma group) were successfully visualized (Figures a-h). Collateral-arteries form from the inferior mesenteric artery (Figure a) or de novo arteries from the abdominal aorta (Figure b) after superior mesenteric artery occlusion (Figure c, d). In patients with thymoma, an SVC thymoma disrupts venous return in the neck and upper extremities; a complex venous system forms on the abdominal surface (Figure e-h). Conclusion In TA and thymoma patients, before planning surgical procedures, a complex artery/venous system should be examined using 3D volume rendering CT angiography. For CT in thymoma, diluted (1/4) iodinated contrast should be injected in both medial cubital veins, and images should be acquired 10 seconds after contrast-injection. 3D volume rendering CT angiography Funding Acknowledgement Type of funding source: None

Endovascular treatments of tunneled central venous catheter-induced superior vena cava complete occlusion via through-and-through technique.

Superior vena cava occlusion (SVCO) induced by tunneled central venous catheter (tCVC) is an uncommon but challenging complication of hemodialysis patients. The aim of this study was to access the efficacy, safety, and patency of stents in tCVC-related SVCO via through-and-through technique. We retrospectively identified seven patients with benign SVCO secondary to tCVC treated with endovascular approaches successfully between 1 March 2013 and 31 October 2019. Patients' demographic data, clinical signs and symptoms, and imaging data were followed up and recorded. Technical success was achieved in all cases. All the patients were performed with percutaneous transcatheter angioplasty (PTA) and subsequently stent placement via the through-and-through technique. During follow-up, four patients underwent secondary interventions, including PTA and/or stent placement. The primary patency after 3, 6, 9 and 12 months was 100%, 100%, 86% and 86%, and secondary patency after 12 months was 100%. No procedure-related deaths occurred. Endovascular management of SVCO is a safe and effective approach. CT examination can provide a direction for endovascular treatment and periodic surveillance.