Superior vena cava syndrome due to thrombotic occlusion in a thrombophilic renal transplant recipient: a case report.
The case of a superior vena cava syndrome due to a central venous catheter thrombosis occurring in a second renal transplant patient is described. Imaging revealed thrombosis of the right internal jugular vein with extension along the confluence of the brachiocephalic veins and partial obstruction of the superior vena cava. Anticoagulant therapy with subcutaneous low-molecular-weight heparin was followed by warfarin administration. Despite adequate treatment, the symptomatology worsened because of thrombus organization. A workup revealed a complex prothrombotic underlying condition. Cardiothoracic surgeons were consulted, and an operative reconstruction of the superior vena cava using spiral vein bypass grafting was performed. In this report we describe the clinical presentation, diagnosis, and treatment of this case, with an emphasis on the role of thrombophilia.
Transplant and Renal Failure Unit, Department of Surgery, University of l'Aquila, Italy.
P
P
Di Cocco
G
G
Orlando
E
E
Di Cesare
C
C
Mazzotta
V
V
Rizza
F
F
Pisani
A
A
Famulari
R
R
Gregorini
A
A
Mazzola
M
M
Lapecorella
D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007601:Jugular Veins / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D012086:Reoperation / Q000009:adverse effects; D013479:Superior Vena Cava Syndrome / Q000209:etiology* / Q000601:surgery; D013923:Thromboembolism / Q000188:drug therapy / Q000209:etiology; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin