Anatomic bifurcated reconstruction of chronic bilateral innominate-superior vena cava occlusion using the Y-stenting technique.
This article presents the case of a 42-year-old man who presented with superior vena cava (SVC) syndrome due to fibrosing mediastinitis with multiple failed attempts at recanalization. We initially treated him with unilateral sharp needle recanalization of the right innominate vein into the SVC stump followed by stenting. Although his symptoms improved immediately, they did not completely resolve. Six months later, he returned with worsening symptoms, and venography revealed in-stent restenosis. The patient requested simultaneous treatment on the left side. The right stent was dilated, and a 3-cm-long occlusion of the left innominate vein was recanalized, again using sharp needle technique, homing into the struts of the right-sided stent. Following fenestration of the stent, a second stent was deployed from the left side into the SVC, and the two Y limbs were sequentially dilated to allow a true bifurcation anatomy (figure). The patient had complete resolution of his symptoms and continues to do well 6 months later.
Department of Surgery, University of Iowa, Iowa City, IA, USA. parth-amin@uiowa.edu
Parth
P
Amin
Mel J
MJ
Sharafuddin
Chad
C
Laurich
Rachael M
RM
Nicholson
Raphael C
RC
Sun
Simon
S
Roh
Timothy F
TF
Kresowik
William J
WJ
Sharp
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D002404:Catheterization / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications*; D010690:Phlebography / Q000379:methods; D011474:Prosthesis Design; D012008:Recurrence; D012598:Sclerosis / Q000150:complications*; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging
D000925:Anticoagulants