title: A "Train-Track" Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection.
abstract: This report describes a stenting technique used to anatomically reconstruct superior vena cava (SVC) bifurcation in a patient with benign SVC syndrome. After recanalizing the SVC bifurcation, we exchanged two 0.035-in. wires for two 0.018-in. wires, deployed the SVC stent over these two wires ("train-track" technique), and stented each innominate vein over one wire. However, our decisions to recanalize both innominate veins, use the "buddy-wire" technique for SVC dilation, and dilate the SVC to 16 mm before stent deployment likely contributed to SVC tear, which was managed by resuscitation, SVC stent placement, and pericardial drainage. Here, we describe the steps of the train-track technique, which can be adopted to reconstruct other bifurcations; we also discuss the controversial aspects of this case.
authors.affiliation: Section of Vascular and Interventional Radiology, Imaging Institute, L10, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. karuppk@ccf.org.
authors.forename: Karunakaravel
authors.identifier: http://orcid.org/0000-0003-4121-8148
authors.initials: K
authors.lastname: Karuppasamy
authors.affiliation: Section of Vascular and Interventional Radiology, Imaging Institute, L10, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Natour
authors.affiliation: Section of Vascular and Interventional Radiology, Imaging Institute, L10, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Ram Kishore
authors.initials: RK
authors.lastname: Gurajala
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods; D002305:Cardiac Tamponade / Q000150:complications / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000150:complications / Q000601:surgery* / Q000628:therapy; D014683:Vena Cava, Superior / Q000601:surgery
keywords: Bifurcation stenting; Central venous recanalization; Reconstruction of bifurcation; Y-stenting