title: Endovascular stenting in superior vena cava syndrome: utility of a through-and-through guidewire technique.
abstract: OBJECTIVE
  To describe an ancillary technique when a conventional femoral approach to superior vena cava (SVC) stent placement is not feasible because of buckling of balloon catheters or stent-deployment systems during device advancement.
  
  
  METHODS
  Three patients in whom device advancement across the SVC lesion from a femoral or axillary approach was unsuccessful were managed by accessing the right jugular vein; SVC lesions were crossed from an antegrade direction, and the jugular guidewire was secured at the femoral access site to create a through-and-through guidewire.
  
  
  RESULTS
  Countertraction on the through-and-through guidewire during stent placement and dilation permitted unhindered advancement of stent delivery systems and catheters across the SVC. Technical and clinical success was achieved in each patient with relief of SVC syndrome within 24-72 hours. Survival ranged from 26 to 137 days.
  
  
  CONCLUSIONS
  A through-and-through guidewire technique is useful when stenting a highly stenotic or thrombosed SVC in patients with superior vena cava syndrome.
authors.affiliation: Department of Diagnostic Imaging, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS.
authors.forename: T W
authors.initials: TW
authors.lastname: Clark
mesh_terms: D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008175:Lung Neoplasms / Q000150:complications; D008875:Middle Aged; D011859:Radiography; D015642:Radiology, Interventional; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*