Treatment of catheter-induced thrombotic superior vena cava syndrome: a single institution's experience

 Thrombosis is the most frequent benign etiology of superior vena cava syndrome among cancer patients who have a long-term central venous catheter. In this paper, six cases of thrombotic superior vena cava syndrome are discussed. There were four women and two men. One patient was treated with streptokinase and five with urokinase. The mean age was 46 years (range 22–69), and the mean time for thrombosis development after catheter insertion was 125 days (range: 53–211 days). The mean time for resolution of thrombosis was 7 days (range 2–11) in five patients. One patient had no response to fibrinolysis. Published online: 20 April 2000     

Suppurative thrombosis of the superior vena cava: a lethal complication of central venous catheters

A case is described, in which suppurative thrombosis of the superior vena cava, complicated central venous catheterization. Persistent septicaemia resulted which was unresponsive to medical management and was ultimately fatal.     

Long-term central venous catheterization via persistent left superior vena cava

We report a case of a cancer patient who displayed a persistent left superior vena cava (PLSVC) after implantation of a central venous catheter (Port-a-Cath), as revealed by angiography. This anomaly is rather rare (0.3% of healthy individuals), and the few studies on the long-term maintenance of an implant in situ are not very informative. Nevertheless, based on the acceptable venous caliber and the patient's serious clinical situation, we decided to leave the catheter in place and perform infusional chemotherapy and supportive therapy with careful and continuous control. The patient died after 8 months of this therapy. No complications attributable to the catheter were observed. We think that the risk is acceptable in similar conditions.     

上腔静脉阻塞综合征的护理

目的探讨上腔静脉阻塞综合征的护理方法。方法对20例恶性肿瘤并发上腔静脉阻塞综合征的护理过程进行回顾性分析,总结上腔静脉阻塞综合征的观察要点及护理方法。结果经过积极治疗和系统护理后,16例症状缓解,4例未见缓解。结论对易并发上腔静脉阻塞综合征的肿瘤患者要严密观察病情,及早发现阻塞症状并积极处理,既可缓解症状,又可延长无复发生存期。     

上腔静脉综合征的超声诊断

目的分析上腔静脉综合征(SVCS)的超声特征,评价其超声诊断价值.方法应用二维及多普勒超声心动图,经右锁骨上窝及心尖五腔切面观对21例SVCS患者及20例健康志愿者行上腔静脉及相关部位的超声检测.结果本组21例SVCS患者,包括纵隔及周围组织病变致外压型15例,上腔静脉腔内血栓5例,纵隔畸胎瘤术后致上腔静脉瘢痕性狭窄1例.外压型见上腔静脉内径较正常组明显变细[(6.7±7.4)mm vs(11.4±2.1)mm,P＜0.001],血流速度加快[(128.0±40.9)cm/s vs(50.3±8.2)cm/s,P＜0.01],2例上腔静脉狭窄严重者血流速度减慢.5例腔内型SVCS均见上腔静脉腔内血栓,彩色血流信号变弱,血流速度变慢[(16.4±6.9)cm/s vs(50.3±8.2)cm/s,P＜0 011.结论超声检查不但可以评价SVCs病变部位及程度,同时还能提供其病因诊断.     

Surgical management of Candida suppurative thrombophlebitis of superior vena cava after central venous catheterization

Septic deep venous thrombosis is a major complication associated with central venous catheterization in intensive care units. The most common causative organisms are Staphylococcus aureus, gram-negative bacilli and Candida species. The incidence of Candida infections is increasing, especially in intensive care patients receiving total parenteral nutrition and long-term broad-spectrum antibiotics. Although intravascular catheter-induced septic thrombophlebitis is quite common, superior vena cava obstruction is a rare complication. However, few data exist concerning the best strategy for managing septic thrombophlebitis, especially when medical therapy fails. We report successful surgical management of Candida albicans suppurative thrombosis of the superior vena cava in a young patient. Received: 30 September 1996 Accepted: 15 April 1997     

Left-sided superior vena cava: a not-so-unusual vascular anomaly discovered during central venous and pulmonary artery catheterization.

OBJECTIVE: To report our ICU experience with patients noted to have a left-sided superior vena cava after central venous and pulmonary artery catheterization. DESIGN: Retrospective review. SETTING: Surgical ICUs in a University and Veterans Administration Medical Center. PATIENTS: Five patients who had insertion of central venous or pulmonary artery catheters were noted to have abnormal placement. RESULTS: Five patients were noted to have a left-sided superior vena cava that was not appreciated on preinsertion radiography after central venous (two patients) or pulmonary artery catheterization (three patients). The finding of left-sided superior vena cava was confirmed by computed tomography scan (one patient), transesophageal echocardiography (one patient), bolus contrast injection (two patients), and intraoperative inspection (one patient). CONCLUSIONS: Left-sided superior vena cava occurs infrequently, most often in association with a right-sided superior vena cava. It is often associated with cardiac septal defects. The intensivist should be aware of its occurrence in order to not mistake catheters placed in it as being present in the arterial circulation or malpositioned outside of the venous circulation.     

Persistent left superior vena cava — an unusual location of central venous catheters in children

The incidence of central venous catheters inadvertently placed in a persistent left superior vena cava (PLSVC) was found to be 1.0% in a pediatric population requiring central venous catheterisation. Two well documented cases are presented and the possible association of PLSVC with other non-cardiovascular malformations is suggested.     

Accidental venous port placement via the persistent left superior vena cava: Two case reports

BACKGROUNDBreast cancer poses a great threat to females worldwide. There are various therapies available to cure this common disease, such as surgery, chemotherapy, radiotherapy, and immunotherapy. Implantable venous access ports (IVAP, referred to as PORT) have been widely used for breast cancer chemotherapy. Venous malformations are possible conditions encountered during PORT implantation. Persistent left superior vena cava (PLSVC) is a common superior vena cava malformation. Most patients have normal right superior vena cava without affecting hemodynamics, so patients often have no obvious symptoms.CASE SUMMARYWe incidentally found that two patients had PLSVC while a PORT was implanted via the internal jugular vein. Due to chemotherapy for breast cancer, PORT was successfully implanted under the guidance of ultrasound into these 2 patients. Positive chest X-ray examination after the operation showed that the catheter ran beside the left mediastinum and the end was located in the seventh thoracic vertebra. The patients had no catheter-related complications and successfully completed the course of chemotherapy. Ultrasonography found that the ratio of PORT outer diameter to PLSVC inner diameter was less than 0.45, which was in line with the recommendations of relevant literature and operating guidelines. The purpose of this article is to introduce two rare cases and review the relevant literature.CONCLUSIONCorrect assessment of PLSVC status and ultrasound-guided PORT placement generally does not affect breast cancer patients chemotherapy.     

Percutaneous stenting of malignant superior vena cava syndrome in a patient with persistent left and absent right superior vena cava

Stent placement is the preferred means of managing malignant obstruction of the superior vena cava (SVC). Persistent left and absent right SVC is a very rare venous anomaly. We here report the case of a 58-year-old man who underwent percutaneous stenting for malignant persistent left and absent right SVC obstruction caused by advancement of adenocarcinoma of the upper lobe of the left lung. The patient became symptom-free one day after endovascular stenting through the right femoral vein. However, he experienced repeated supraventricular tachycardia during the procedure. To our knowledge, this is the first report of stenting for malignant SVC obstruction with this congenital anomaly.     

Malignant superior vena cava syndrome presenting after trauma

A 41-year-old man was brought to the ED after a motor vehicle crash. On presentation, he demonstrated symptoms compatible with superior vena cava (SVC) syndrome, including extreme dyspnea, face and neck cyanosis and facial swelling. A chest tube was inserted and drained large amounts of sanguineous fluid. An exploratory thoracotomy revealed an extensive tumour encasing the SVC and the hilum. Biopsy confirmed the diagnosis of T-cell lymphoma. The most common cause of SVC syndrome is malignant disease, with bronchogenic carcinoma and lymphoma being most frequent. Review of the literature uncovered only a few anecdotal reports of traumatic SVC syndrome. There are no previous reported cases of malignant SVC syndrome presenting in association with trauma.