Superior Vena Cava Research Articles

Percutaneous access to the right atrium through the site of superior vena cava occlusion to re-catheterization for a maintenance hemodialysis patient with central venous obstruction.

Central venous catheters are commonly used for hemodialysis, but prolonged use can lead to complications such as central venous occlusion, resulting in catheter-dependent dialysis patients being unable to undergo dialysis. Herein, we present the case of a 57-year-old female patient who had been dependent on catheter-based hemodialysis for 8 years. Her tunneled central venous catheter (TCC) had been replaced three times and she had developed severe central venous occlusion. For this patient, a procedure was performed involving a percutaneous puncture through the site of superior vena cava occlusion to gain access to the right atrium. The intervention utilized multiple surgical instruments, including a transseptal needle in combination with the stiffening cannula from the RUPS-100 Suite, to facilitate re-catheterization for maintenance hemodialysis. We discuss the feasibility of such procedures as a last-resort option while emphasizing the associated risks.

Evaluation of Three-Vessel View Intervessel Distance Measurements in Fetuses Without Congenital Cardiac Defects.

We aimed to compare the intervessel distances on standard 3-vessel views during fetal echocardiography across nonanomalous fetuses between 18 and 23 weeks' gestation. The intervessel measurements included the distances between the main pulmonary artery (PA) and ascending aorta (Ao) (PA-Ao), between Ao and superior vena cava (SVC) (Ao-SVC), and between PA and SVC (PA-SVC). Throughout a 2-year period, 95 low-risk pregnancies as controls were included. Two evaluators measured intervessel distances from archived images. Scatter plots that included gestational age, femur length (FL), biparietal diameter (BPD), and intervessel distance measurements for nonanomalous fetuses were formed. Inter- and intraobserver reliabilities were assessed by intraclass correlations (ICC). In normal fetuses, PA-Ao and Ao-SVC distance values did not significantly change (p = 0.62 and p = 0.09, respectively), although PA-SVC distance measurements increased (p = 0.0001) with increasing gestational weeks. Interobserver and intraobserver agreement for PA-Ao distance were moderate (ICC, 0.63) and high positive (ICC, 0.79); for Ao-SVC distance, it was low positive (ICC, 0.47) and moderate (ICC, 0.59); for PA-SVC distance, it was high positive (ICC, 0.76) and high positive (ICC, 0.89), respectively. Reference intervals for intervessel distances PA-Ao, Ao-SVC, and PA-SVC in the three-vessel view at 18-23 weeks of gestation were established.

A Systematic Review of Surgical Strategies for Managing Major Thoracic Vessels in Thoracic Oncology.

The management of locally advanced thoracic malignancies, particularly those involving critical vascular structures, presents substantial surgical challenges. Surgery remains a cornerstone of treatment for these conditions, yet the involvement of the superior vena cava (SVC), pulmonary artery (PA), aorta, and thoracic outlet vessels complicates the process. The literature search was performed from January 1990 to January 2025 in PubMed, Embase, and Cochrane according to PRISMA guidelines. Through the process of evidence acquisition, 78 types of research were identified: 27 focusing on SVC, and 25 focusing on PA, 15 focusing on the aorta, and 11 focusing on thoracic outlet vessels. The findings indicated that surgical management of the SVC and PA, although feasible, carries significant risks. The perioperative mortality for SVC surgeries ranged from 0 to 17%, with morbidity varying between 0 and 50%. For PA surgeries, the perioperative mortality ranged from 0 to 17.2% and morbidity ranged from 0 to 62%. Extended resections, including partial and total aortic resections, offered long-term survival rates of 25% to 40% for carefully selected patients. Vascular reconstructions, such as subclavian artery resection followed by bypass, demonstrated a 70% success rate with a 35% 5-year survival rate. Vascular reconstructive techniques significantly extend surgical resection options, offering lung-sparing procedures for patients with bulky mediastinal masses and avoiding pneumonectomy in functionally challenging cases. Although advancements such as aortic endografting and cardiopulmonary bypass have improved outcomes, challenges such as hemorrhage, vascular injury, and neurologic deficits persist.

Distribution Variance of Focal Atrial Tachycardia Foci and Long-Term Outcomes After Ablation: Experience From Two Chinese Centers.

The distribution of the origin of focal atrial tachycardia (FAT) in patients with different ages have not been clearly elucidated. We aimed to evaluate age differences in foci and factors influencing recurrence after radiofrequency catheter ablation in adult and juvenile patients with FAT. A total of 323 consecutive FAT patients who underwent electrophysiological study and radiofrequency catheter ablation between January 2011 and March 2023 were selected for this study. We divided the patients into three groups according to the age of FAT onset: juvenile (< 18 years), young adult (≥ 18 and < 45 years), and middle-aged and old adult (≥ 45 years). Juvenile had a higher proportion of FAT originating from the left atrial appendage, the right atrial appendage, and the free or posterior wall of the right atrium. FAT in middle-aged and old adult patients was more likely to originate from the crista terminalis, tricuspid annulus, non-coronary cusp, and para-His. Young adults had a higher proportion of FAT originating from the superior vena cava and pulmonary veins. After a mean follow-up of 47.2 months, FAT recurred in 57 patients. Multivariate Cox regression analysis suggested that multifocal ablation (HR: 3.055, 95% CI: 1.476-6.323) and NT-proBNP (per standard deviation, HR: 1.367, 95% CI: 1.157-1.614) were independently associated with arrhythmia recurrence after ablation. Significant age differences were observed in the distribution of FAT foci. Multifocal AT and elevated NT-proBNP independently predicted FAT recurrence after ablation.

The Vestigial Fold in Humans: Characterization of a Potential Novel Target for Selective Cardiac Sympathetic Denervation.

The Vestigial Fold in Humans: Characterization of a Potential Novel Target for Selective Cardiac Sympathetic Denervation.

Treatment Strategies for Refractory Catheter-Related Central Venous Occlusive Disorders: Review.

Catheter-related central vein occlusive disease (CVOD) is a frequent complication in hemodialysis patients and significantly affects their prognosis. Current treatment options for catheter-related CVOD include standard guidewire and catheter techniques, radiofrequency ablation, and sharp recanalization. However, large-scale clinical trials evaluating these techniques are lacking, making CVOD management challenging. This article reviews current treatment strategies for catheter-related CVOD. A comprehensive literature review was conducted via PubMed, focusing on studies evaluating the effectiveness and safety of various treatment modalities for CVOD. The following keywords were used in PubMed: "hemodialysis", "central vein occlusion", "central vein stenosis", and "catheter". The treatment methods for refractory CVOD in hemodialysis patients are diverse, including sharp recanalization, radiofrequency ablation, and percutaneous superior vena cava puncture. Complications and success rates vary widely across treatments, and evidence is generally limited to small studies or case series. However, a standardized treatment protocol is still lacking. While several techniques show promise in treating catheter-related CVOD, high-quality clinical studies are necessary to identify the more effective and safe procedure. The choice of treatment should be based on individual patient characteristics, extent of the occlusion, and available resources. Percutaneous SVC puncture may be a feasible alternative after failed sharp recanalization for refractory CVOD.

Tetralogy of Fallot, Absent Vena Cava Superior, Persistent Left Vena Cava Superior, and Interrupted Vena Cava Inferior: A Case of Struggle in Open Heart Surgery

Interruption of vena cava inferior (VCI) is extremely rare, in occurrence in isolation or association with asplenia or polysplenia syndromes. In this abnormality, the infrahepatic segment of the VCI is absent, by representing the inadequacy of fusion of subcardinal embryological parts of the VCI. It is compensated by an azygos or hemiazygos vein that continues on the posterior wall of the thoracic cavity. In this case report, a case of incidentally diagnosed interrupted VCI in a patient diagnosed with tetralogy of Fallot (TOF), major aortopulmonary collateral artery (MAPCA), right arcus aorta, absence of right vena cava superior (VCS), and persistent left vena cava superior (PLVCS), and its successful surgical treatment was presented. If the hepatic vein confluence is of adequate size, the cannulation for cardiopulmonary bypass circuit through the hepatic vein confluence is safe in case of interrupted VCI.

The safety of direct transeptal puncture using a radiofrequency guidewire combined with a 17Fr pulsed field ablation sheath

Transseptal puncture (TSP) is widely used in catheter-based cardiac interventions to gain left atrial (LA) access, but its workflow has remained largely unchanged and is still a source of serious complications. Pulsed field ablation (PFA) for pulmonary vein isolation (PVI) has been shown to be at least comparable with radiofrequency ablation (RFA) in terms of safety and efficacy. However, PFA catheter delivery to the LA typically requires a standard TSP and an over the wire sheath exchange which can limit workflow and lengthen procedure time—a shorter procedure time being a proposed advantage of PFA over RFA. This study aimed to evaluate a simplified workflow for direct TSP using the PFA sheath (Faradrive, Boston Scientific). We retrospectively analyzed 166 patients undergoing PVI with PFA in our center. TSP was performed by combining a 16.8F PFA sheath (Faradrive, Boston Scientific) and a RF-guidewire (Versacross, Boston Scientific) as a direct approach without the need over an over-the-wire exchange. The patient population had a mean age of 63.8 ± 11.3 years and was 72.3% male (n = 119/166). TSP was achieved in all patients (n = 166, 100%) without complication. The mean time from groin puncture to LA ablation catheter delivery was 16.2 ± 5.5 min with a mean fluoroscopy time of 15.7 ± 12.7 min. Dilator and sheath crossed the septum with no significant resistance in all cases (n = 168, 100%). The RF-guidewire allowed catheters to be tracked back up to the superior vena cava without exchange in cases where another dropdown was desired to locate a preferred puncture site. The stiffness of the wire provided adequate support to advance all sheaths to the left side regardless of outer diameter. This is the first case series on the use of a RF-guidewire combined with the PFA sheath for TSP. This study proved that an over a RF-powered guidewire TSP directly with 16.8F PFA sheath is feasible, reproducible, and safe. This very simplified workflow eliminates the need for both a rigid metal needle and an over the wire sheath exchange reducing procedure time and complexity, fluoroscopy time and potential related risks.

Oncological Crisis: Managing Superior Vena Cava Syndrome in the Emergency Department

Superior vena cava syndrome (SVCS) results from obstruction of the superior vena cava (SVC) and is commonly associated with malignancies. However, its presentation can vary, and in rare cases, it may present as an oncological emergency with atypical symptoms. A 54-year-old male presented to the Emergency Department (ED) with syncope, breathlessness, and fever. Clinical examination revealed elevated jugular venous pressure, hypoxia, and engorged veins. Imaging identified superior vena cava obstruction due to a compressing mediastinal mass, alongside lung hyperinflation and emphysema. The patient’s history included Chronic Obstructive Pulmonary Disease (COPD) and extensive smoking. In the ED, he was managed with oxygen therapy, corticosteroids, and nebulization. A biopsy confirmed malignancy, and the patient was subsequently treated with chemotherapy. This case highlights the rare presentation of malignant SVCS as syncope and emphasizes the importance of including SVCS in the differential diagnosis for patients with a history of malignancy presenting with breathlessness and engorged veins. Effective management in the ED requires a multidisciplinary approach to address the complexities of oncological emergencies and improve patient outcomes. Keywords: Superior vena cava syndrome, Mediastinal mass, Chronic obstructive pulmonary disease, Emergency department, R-CHOP Regimen

Comparison of the efficacy and safety of pulmonary vein cryoballoon ablation alone and with additional isolation of the superior vena cava in patients with persistent atrial fibrillation

Aim. To study the impact and safety of cryoballoon ablation of the pulmonary vein (PV), supplemented by isolation of the superior vena cava in patients with persistent atrial fibrillation (AF).Methods. The study is single-center, randomized, prospective. The total number of patients was 40. All of them underwent cryoballoon isolation of the PV for persistent AF. The patients were then divided into two groups: the first group included patients who underwent the standard procedure, and the second group included patients with the standard procedure supplemented by isolation of the superior vena cava. Patients in both groups had similar anatomical and clinical-anamnestic parameters. The duration of the surgical intervention was not statistically different.Results. The average follow-up period was 354±19 days. In the group of classical cryoballoon PV isolation, after 12 months of observation without antiarrhythmic therapy, sinus rhythm was maintained in 40% of patients (8 people), in the group of extended cryoballoon PV isolation - in the same number of patients (40%, P=1). In the PV isolation group, persistent phrenic nerve palsy was observed in no patients, and in the extended ablation group, in eight patients (40%, P=0.0016). At the end of the observation, no remote complications were registered.Conclusions. In patients with persistent AF, cryoballoon PV isolation supplemented by superior vena cava isolation is a less safe technique than standard cryoballoon pulmonary vein isolation, with comparable efficacy.

A Retrospective Case-Control Study Examining the Association of Thyroid-Stimulating Hormone Suppression and Vascular Wall Inflammation on [18F]FDG-PET/CT.

Background: This retrospective case-control study aimed to investigate the effects of thyroid-stimulating hormone (TSH) suppression on vascular wall inflammation, assessed by [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT). Vascular [18F]FDG-uptake is highly correlated with arterial inflammation, which represents a major risk factor for atherosclerotic plaques. Methods: Forty patients with differentiated thyroid cancer underwent [18F]FDG-PET/CTs under TSH suppression therapy following surgical removal of the thyroid and subsequent radioiodine ablation. The [18F]FDG-uptake was measured in the carotid arteries, aortic arch, and the ascending, descending, and abdominal aorta. All measurements in the PET scans were normalized to body weight and corrected for blood pool activity in the superior vena cava, creating target-to-background ratios (TBRs). Twenty-five patients with euthyroid hormone status were used as a control group. In addition, to evaluate long-term changes, the follow-up PET/CTs of 24 thyroid carcinoma patients under continued TSH suppression therapy were analyzed. Results: In patients with TSH suppression, significantly higher arterial [18F]FDG-uptake (p < 0.001) was observed in the ascending aorta, aortic arch, abdominal aorta, carotid artery, and for all arterial vessels combined (mean TBRmax ± standard deviation [SD]: 1.8 ± 0.4, 1.8 ± 0.3, 1.9 ± 0.4, 1.4 ± 0.3, 1.7 ± 0.2, respectively) compared with the euthyroid control group (TBRmax ± SD: 1.4 ± 0.2, 1.4 ± 0.2, 1.4 ± 0.2, 1.1 ± 0.2, 1.3 ± 0.1, respectively). In the subgroup of patients who received an additional follow-up scan after a mean duration of 1.9 ± 1.1 years of continued TSH suppression therapy, no significant changes in arterial [18F]FDG-uptake were found in the five arterial sites when both scans were compared over time (p > 0.05). Conclusions: Our study suggests that patients under TSH suppression may experience a significant increase in vascular [18F]FDG-uptake, a marker of arterial inflammation, and, therefore, might be at higher risk for cardiovascular disease. Interestingly, the duration of TSH suppression was not significantly associated with vascular [18F]FDG-uptake in our study, indicating that the observed increase in arterial inflammation may not be influenced by the duration of TSH suppression.

Steps to improve the outcome of a single ablation procedure for paroxysmal atrial fibrillation: Significance of a burst stimulation-guided ablation strategy.

Steps to improve the outcome of a single ablation procedure for paroxysmal atrial fibrillation: Significance of a burst stimulation-guided ablation strategy.

Nanosecond vs Microsecond Pulsed FieldAblation: Lesion Durability and Muscle Contraction in a Canine Model.

Nanosecond vs Microsecond Pulsed FieldAblation: Lesion Durability and Muscle Contraction in a Canine Model.

Optimization of head and neck vascular CT angiography using variable rate bolus tracking technique and third-generation dual-source CT dual-energy scanning

ObjectiveTo evaluate the effectiveness of the variable rate bolus tracking technique combined with third-generation dual-source CT dual-energy scanning in enhancing the quality of head and neck vascular CT angiography (CTA).MethodsWe conducted a retrospective analysis of 202 patients who underwent head and neck vascular CTA using a third-generation dual-source CT with dual-energy scanning. Patients were divided based on the contrast injection method into two groups: the variable-rate bolus tracking group (Group A, n = 100) and the fixed flow rate group (Group B, n = 102). We compared subjective image quality, venous artifacts, and objective image quality parameters between the two groups.ResultsThe amount of contrast agent used in Group A was significantly lower than in Group B. Additionally, mean attenuation values of arterial segments in Group A were markedly lower than those in Group B. Compared to Group B, attenuation values of the intracranial venous sinuses, right jugular vein, superior vena cava, right subclavian vein, and left jugular vein in Group A showed significant reductions. No significant difference was observed in the subjective image quality between the two groups. However, venous artifact in the right subclavian vein was significantly diminished in Group A.ConclusionThe application of the variable rate bolus tracking technique alongside third-generation dual-source CT dual-energy scanning in head and neck vascular CTA can achieve high-quality imaging while reducing contrast agent dosage. It enhances the attenuation contrast of intracranial arteries and veins and minimizes residual contrast and artifacts in the right subclavian vein.

Improvement of aortic exposure by superior vena cava snaring and traction during lower partial sternotomy

Improvement of aortic exposure by superior vena cava snaring and traction during lower partial sternotomy

Persistent Left Superior Vena Cava inPacemaker Implantation for Digoxin-Induced Complete Heart Block: Clinical Considerations and Challenges.

Duplication of the superior vena cava is a rare congenital anomaly. Although often asymptomatic, this anatomical variation can complicate cardiovascular procedures, particularly those involving central venous access. We present the case of an 82-year-old female with multiple comorbidities, who was incidentally found to have a persistent left superior vena cava (PLSVC) during pacemaker implantation for digoxin-induced complete heart block. The initial pacemaker implantation on the left side was unsuccessful due to resistance, which led to the identification of PLSVC via contrast-enhanced CT scan. The procedure was successfully completed by shifting the implantation to the right side. This case highlights the importance of recognizing venous anomalies such as PLSVC during interventional procedures, as early identification can prevent complications and inform surgical strategy. Awareness of such congenital variations is essential, particularly in patients with complex medical histories.

Navigating the challenge of an isolated persistent left superior vena cava in cardiac procedures

Navigating the challenge of an isolated persistent left superior vena cava in cardiac procedures

Supracardiac total anomalous pulmonary venous drainage with right-sided vertical vein draining into the proximal superior vena cava

Supracardiac total anomalous pulmonary venous drainage with right-sided vertical vein draining into the proximal superior vena cava

Maintenance of peripherally inserted central catheters in general pediatric wards.

The peripherally inserted central catheter (PICC) has emerged as a useful option for long-term intravenous access in children, which has been increasingly required with the advancements in pediatric care. Long-term maintenance of PICCs is important for their functions, but little is known about this. We aimed to describe the PICC dwelling time in general pediatric wards, taking both complications and intentional routine removal into consideration, and explore the factors for long-term maintenance. We retrospectively examined the records of procedures performed by the pediatric PICC team between April 2020 and September 2023 at a children's hospital in Japan. We conducted a survival time analysis to depict PICC dwelling time and regression analyses to explore factors associated with successful PICC insertion and long-term maintenance of catheters. The PICC team conducted 78 procedures during the study period, 66 (85%) achieved central venous access, and 57 (78%) of 73 inserted PICCs could be used until treatment completion. The most common indication was administration of antibiotics. Radioscopy was utilized in 18% of procedures. The median PICC survival time was 170 days, and the 75% PICC survival time was 52 days. Failure of PICC insertion was associated with the 4.5 Fr double catheter (odds ratio (OR), 0.16) and lower extremity puncture (OR, 0.24). Longer catheter survival was associated with the catheter tip in the superior vena cava (SVC; hazard ratio (HR), 0.15), which was confirmed by additional multivariate analysis (HR, 0.14). PICCs could be used for several months in children until complications required removal. Single-lumen catheter insertion into the SVC might be associated with longer catheter survival. Developing appropriate methods to reach the SVC remains our task.

The Appearance of a Secondary Bone Lesion in Place of Nonspecific Vertebral Anomalies Related to Mediastinal Venous Thrombosis: Coincidence?

A 66-year-old woman with locally advanced lung adenocarcinoma underwent FDG-PET/CT, which revealed superior vena cava invasion and thrombosis of the brachiocephalic veins. Tracer injection on the side of thrombosis demonstrated hypermetabolism in the dorsal spine, likely due to collateral venous drainage. Following chemoradiotherapy and early discontinuation of immunotherapy for toxicity, she developed cervicobrachial neuralgia 18 months later. MRI showed marrow replacement lesions and FDG-PET/CT identified bone recurrence at D1, correlating with previously nonspecific fixation abnormalities. This case raises the question of whether vertebral venous stasis may favor metastatic grafting and highlights the potential need for contralateral FDG injection.