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1.
Veroux P Veroux M Bonanno MG Tumminelli MG Baggio E Petrillo G 《European radiology》2002,12(Z3):S181-S184
The most likely etiology of benign obstruction of the superior vena cava (SVC) include fibrosing mediastinitis and iatrogenic etiologies such as sclerosis and obstruction caused by pacemakers and central venous catheter. Percutaneous stenting of SVC has been used with success both in malignant and benign superior vena cava syndrome; however, long-term follow-up of endovascular procedures is not well known. We present a case of a patient with complete occlusion of SVC of benign etiology, presenting dramatically with bilateral chylothorax and chylopericardium with cardiac tamponade, who underwent successful vena caval revascularization with thrombolytic therapy and placement of self-expanding metallic stent. The 42-month follow-up could encourage endovascular procedures even in SVC syndrome of benign etiology. 相似文献
2.
Miller JH McBride K Little F Price A 《Cardiovascular and interventional radiology》2000,23(2):155-158
Over a 3-year period 23 patients with malignant superior vena cava obstruction were referred for interventional management. They underwent repeat localized central venography and deployment of self-expanding Wallstents. All patients (age range 26-89 years) were approached by the subclavian route using 29 stents. The stent was used to exclude thrombus in the contralateral brachiocephalic vein in five patients and histologic information was available in all patients. Retrospective analysis of the clinical records was used to assess symptom-free survival and symptom recurrence. All patients reported an improvement in symptoms within 24 hr of the procedure. There was 100% technical success. Primary clinical success was achieved in 19 of 23 patients followed-up to their death with no symptom recurrence (range 1-34, mean 15 weeks). In four patients symptoms recurred but only one patient was referred for re-intervention, which was successful. Complications included single cases of early post-stent rethrombosis, distal slip on deployment, and distal slip on balloon dilatation. There were no puncture-related complications. 相似文献
3.
J. Duncan Irving Robert F. Dondelinger John F. Reidy Hans Schild Robert Dick Andreas Adam Manuel Maynar Christoph L. Zollikofer 《Cardiovascular and interventional radiology》1992,15(5):328-333
Twenty-five patients with stenosis of the vena cava (21) and other large veins (4) have been treated with self-expanding Gianturco
metallic stents. Eighteen patients had superior vena cava syndrome. In 17, the stricture was due to malignant superior vena
cava compression recurrent after maximum tolerance radiotherapy and/or chemotherapy. In 16 of these patients there was early
symptomatic relief. In 1 patient with a benign posttraumatic superior vena cava stricture, the stenosis was not relieved,
and occlusion occurred after 1 month. Stenoses associated with dialysis shunts were relieved in 2 other patients. Two malignant
and one benign inferior vena cava stenoses were relieved either until death, or in the benign case, for 30 months. One malignant
subclavian vein obstruction occluded after 24 h due to stent misplacement and another with extrinsic mediastinal compression
remained patent until death, extensive thrombus having been lysed prior to stent placement. The results of this short series
suggest that the Gianturco self-expanding stent in the vena cava and large veins is easy and safe to place, and in most cases
produces almost immediate palliation of the distressing effects of venous obstruction, often in a preterminal and inoperable
patient. 相似文献
4.
Luc Stockx Henricus Raat Jan Donck Guy Wilms Guy Marchal 《Cardiovascular and interventional radiology》1999,22(3):224-226
Purpose: To describe a combined procedure of repositioning and leaving in situ a central venous catheter followed by immediate percutaneous
treatment of associated superior vena cava syndrome (SVCS).
Methods: Eight patients are presented who have central venous catheter-associated SVCS (n = 6 Hickman catheters, n = 2 Port-a-cath) caused by central vein stenosis (n = 4) or concomitant thrombosis (n = 4). With the use of a vascular snare introduced via the transcubital or transjugular approach, the tip of the central venous
catheter could be engaged, and repositioned after deployment of a stent in the innominate or superior vena cava.
Results: In all patients it was technically feasible to reposition the central venous catheter and treat the SVCS at the same time.
In one patient flipping of the Hickman catheter in its original position provoked dislocation of the released Palmaz stent,
which could be positioned in the right common iliac vein.
Conclusion: Repositioning of a central venous catheter just before and after stent deployment in SVCS is technically feasible and a better
alternative than preprocedural removal of the vascular access. 相似文献
5.
上腔静脉狭窄及阻塞的介入性开通治疗:附六例报告 总被引:7,自引:2,他引:5
报告6例上腔静脉狭窄及阻塞的介入治疗结果,旨在探讨有关技术问题及评价临床疗效。6例中,男5例,女1例,年龄48 ̄74岁,均表现为上腔静脉综合征,5例为肺癌伴纵隔淋巴结转移所致,1例为纵隔淋巴瘤压迫上腔静脉。4例造影表现为重度狭窄,2例为完全性阻塞。介入治疗时,先用导丝通过梗阻段,继而用球囊导管扩张,最后导入金属内支架。结果:6例均开通成功,无重要并发症,术后临床症状明显改善,侧支静脉消失,梗阻远侧 相似文献
6.
Kim HC Chung JW Park SH Kim HB Jae HJ Lee W Park JH 《Acta radiologica (Stockholm, Sweden : 1987)》2004,45(3):269-274
Purpose: To describe computed tomography (CT) venographic appearances of systemic-to-pulmonary venous shunts with CT venography and three-dimensional reconstruction images from patients with superior vena cava obstruction.
Material and Methods: From January 1994 to April 2002, CT venography was performed in 45 patients with superior vena cava obstruction using a single-detector helical CT scanner (n=38) and four-detector row CT scanner (n=7). Analysis of CT scan data included the cause and degree of venous obstruction, the presence of pleural thickening and enhancement, and the attenuation of pulmonary veins. The causative factor for systemic-to-pulmonary venous shunt was evaluated using the Fisher exact test.
Results: Systemic-to-pulmonary venous shunts were observed in four patients (9%) who had high-attenuated pulmonary veins and pleural enhancement on CT venography. Pleural thickening (P=0.01) and a history of pulmonary tuberculosis (P=0.034) are statistically significant risk factors.
Conclusion: CT venography showed strong pleural enhancement and high-attenuated pulmonary veins indicating systemic-to-pulmonary venous shunts. Radiologists should study the earlier enhancement of pulmonary veins in patients with superior vena cava obstruction. 相似文献
Material and Methods: From January 1994 to April 2002, CT venography was performed in 45 patients with superior vena cava obstruction using a single-detector helical CT scanner (n=38) and four-detector row CT scanner (n=7). Analysis of CT scan data included the cause and degree of venous obstruction, the presence of pleural thickening and enhancement, and the attenuation of pulmonary veins. The causative factor for systemic-to-pulmonary venous shunt was evaluated using the Fisher exact test.
Results: Systemic-to-pulmonary venous shunts were observed in four patients (9%) who had high-attenuated pulmonary veins and pleural enhancement on CT venography. Pleural thickening (P=0.01) and a history of pulmonary tuberculosis (P=0.034) are statistically significant risk factors.
Conclusion: CT venography showed strong pleural enhancement and high-attenuated pulmonary veins indicating systemic-to-pulmonary venous shunts. Radiologists should study the earlier enhancement of pulmonary veins in patients with superior vena cava obstruction. 相似文献
7.
Vena Cava 3D Contrast-Enhanced MR Venography: A Pictorial Review 总被引:2,自引:0,他引:2
Lin J Zhou KR Chen ZW Wang JH Yan ZP Wang YX 《Cardiovascular and interventional radiology》2005,28(6):795-805
Three-dimensional contrast-enhanced magnetic resonance venography (CE MRV) is a sensitive and accurate method for diagnosing
vena cava pathologies. The commonly used indirect approach involves a nondiluted gadolinium contrast agent injected into an
upper limb vein or, occasionally, a pedal vein for assessment of the superior or inferior vena cava. In our studies, a coronal
3D fast multi-planar spoiled gradient-echo acquisition was used. A pre-contrast scan was obtained to ensure correct coverage
of the region of interest. We initiated contrast-enhanced acquisition 15 sec after the start of contrast agent injection and
performed the procedure twice. The image sets were obtained during two 20–30-sec breath hold, with a breathing rest of 5–6
sec, to obtain the first-pass and delayed arteriovenous phases. For patients with Budd-Chiari syndrome, a third acquisition
coinciding with late venous phase was collected to visualize the hepatic veins, which was carried out by one additional acquisition
after a 5–6-sec breathing time. This review describes the clinical application of 3D CE MRV in vena cava congenital anomalies,
superior and inferior vena cava syndrome, Budd-Chiari syndrome, peripheral vein thrombosis extending to the vena cava, pre-operational
evaluation in portosystemic shunting and post-surgical follow-up, and road-mapping for the placement and evaluation of complications
of central venous devices. 相似文献
8.
We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava
syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically
implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter
through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using
stent placement and endovascular repositioning of the catheter tip.
Received: 24 April 1999; Revised: 8 February 2000; Accepted: 9 February 2000 相似文献
9.
Unilateral innominate vein obstruction with patency of the superior vena cava was suspected when early jugular--sinuses--jugular reflux of tracer occurred during brain-flow imaging. Radiographic venography confirmed this pattern of venous obstruction. 相似文献
10.
I A Engel Y H Auh W A Rubenstein K Sniderman J P Whalen E Kazam 《AJR. American journal of roentgenology》1983,141(3):521-526
The diagnosis of mediastinal or thoracic inlet venous obstruction can be made reliably by chest computed tomography (CT), and depends on the opacification of collateral venous channels during the continuous infusion of intravenous contrast media. The sectional anatomy of these collateral pathways is illustrated by examples from 50 consecutive patients. An understanding of this anatomy facilitates the diagnosis of obstruction of the superior vena cava or its major tributaries during routine chest CT. Although CT was inferior to contrast venography in opacifying peripheral collateral veins and determining the degree of obstruction, the information provided by CT obviated venography in most patients in this series. CT may be the initial procedure of choice in suspected mediastinal venous obstruction. 相似文献
11.
Expandable wire stents can provide effective palliation of superior vena cava obstruction (SVCO). We describe a case of SVCO unresponsive to radiotherapy and chemotherapy, which was complicated by extensive central venous thrombosis. Successful thrombolysis occurred with low-dose streptokinase allowing subsequent stent placement. 相似文献
12.
Peter Isfort Tobias Penzkofer Fabian Goerg Andreas H. Mahnken 《Korean journal of radiology》2011,12(5):629-633
Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein. 相似文献
13.
Chronic central venous access is necessary for numerous life-saving therapies. Repeated access is complicated by thrombosis
and occlusion of the major veins, such as the superior vena cava (SVC), which then require novel vascular approaches if therapy
is to be continued. We present two cases of catheterization of the azygos system in the presence of an SVC obstruction. We
conclude that the azygos vein may be used for long-term vascular access when other conduits are unavailable and that imaging
studies such as magnetic resonance venography, contrast-enhanced computed tomography or conventional venography can be employed
prior to the procedure to aid with planning and prevent unforeseen complications. 相似文献
14.
Claude Haller Sébastien Déglise Francois Saucy Claudine Mathieu Erik Haesler Francesco Doenz Jean Marc Corpataux Salah Dine Qanadli 《Cardiovascular and interventional radiology》2009,32(4):695-702
A method for hemodialysis catheter placement in patients with central thoracic venous stenosis or occlusion is described and
initial results are analyzed. Twelve patients, with a mean age of 63.2 years (42–80 years), with central venous stenosis or
occlusion, and who required a hemodialysis catheter were reviewed. All lesions were confirmed by helical CT or phlebography.
Five patients had stenosis while seven patients were diagnosed with an occlusion of thoracic central veins. All patients were
asymptomatic, without sign of superior vena cava syndrome. After percutaneous transstenotic catheterization or guidewire-based
recannalization in occlusions, a balloon dilatation was performed and a stent was placed, when necessary, prior to catheter
placement. Technical success was 92%. Three patients had angioplasty alone and nine patients had angioplasty with stent placement.
Dialysis catheters were successfully inserted through all recannalized accesses. No immediate complication occurred, nor did
any patient develop superior vena cava syndrome after the procedure. The mean follow-up was 21.8 months (range, 8–48 months).
Three patients developed a catheter dysfunction with fibrin sheath formation (at 7, 11, and 12 months after catheter placement,
respectively). Two were successfully managed by percutaneous endovascular approach and one catheter was removed. In conclusion,
for patients with central venous stenosis or occlusion and those who need a hemodialysis catheter, catheter insertion can
be reliably achieved immediately after endovascular recannalization with acceptable technical and long-term success rates.
This technique should be considered as an alternative procedure for placing a new hemodialysis catheter through a patent vein. 相似文献
15.
C H Carrasco C Charnsangavej K C Wright S Wallace C Gianturco 《Journal of vascular and interventional radiology : JVIR》1992,3(2):409-419
Twenty-eight patients with severe superior and inferior vena cava syndromes were treated with self-expandable Gianturco stents. Nineteen patients responded, seven did not respond, and two were unevaluable. Fourteen of the 19 who responded had complete or near complete resolution of their syndrome, and five had a partial remission. Five of the responders did not derive any benefit from stent placement because of additional problems that led to their death within 3 weeks of the stent placement procedure. The main cause for failure was the relatively weak expansile force of the stent. Complications included stent migrations without untoward effects in one patient, stent misplacement in one patient, fracture of the stent wire in two patients, and hemorrhage that could be attributed to the stent in one patient. This uncontrolled study suggests that caval obstruction syndromes in some patients may be effectively palliated with Gianturco stents. 相似文献
16.
Imaging findings are presented of an unusual pathway of collateral circulation consisting of bilateral and diffuse dilated breast veins from a patient with long standing superior vena caval syndrome. The main importance of this case is the extent of the collateral development through the breast veins, serving as the major pathway of collateral circulation. Identification of this unusual collateral development, which resembles breast varices, was performed with contrast-enhanced chest CT scans, digital subtraction venography, color Doppler ultrasonography, and mammographic studies. Collateral development was secondary to a long segment idiopathic venous occlusion involving bilateral subclavian and brachiocephalic veins as well as vena cava superior. We conclude that dilated breast veins when detected on any imaging modality should raise the suspicion of central venous obstruction. 相似文献
17.
目的探讨合并静脉血栓形成的布加综合征的介入治疗。方法回顾性分析我科2005年8月~2012年2月收治的39例合并静脉血栓形成的布加综合征患者的临床资料,其中合并下腔静脉血栓形成18例,合并下肢静脉血栓形成21例。结果 18例经股静脉行置管溶栓术,21例经腘静脉行置管溶栓术,经溶栓治疗后行介入治疗,成功36例,成功率92.3%。26例单纯行下腔静脉球囊扩张术,10例行球囊扩张后置入支架,1例术中出现心包填塞严重并发症,终止手术,转心脏外科开胸行下腔静脉修补术;2例闭塞段较长(>7cm),未开通,放弃介入治疗。33例患者得到随访,平均随访52.6个月。随访期内2例下腔静脉膜性狭窄球囊扩张术后分别于6个月和10个月出现再狭窄,后置入支架,症状改善。其余随访患者下腔静脉通畅,支架无脱落及移位。结论置管溶栓联合血管腔内成形术治疗合并静脉血栓形成的布加综合征微创、有效,中远期效果好,应为首选的治疗方法。 相似文献
18.
Wallace MJ 《Journal of vascular and interventional radiology : JVIR》2003,14(10):1339-1343
Two cases of superior vena cava-to-inferior vena cava (IVC) transatrial stent placement to palliate obstruction of the IVC secondary to the intracardiac extension of hepatocellular carcinoma are reported. Both patients presented with debilitating edema of the trunk and lower extremities and varying degrees of hepatic venous obstruction resulting in Budd-Chiari syndrome. One patient required the adjunctive creation of a percutaneous portocaval shunt and the second patient responded to transatrial stent placement alone. Both patients' functional status improved and edema markedly decreased after endovascular therapy. 相似文献
19.
Vena caval and central venous stenoses: management with Palmaz balloon-expandable intraluminal stents. 总被引:2,自引:0,他引:2
J D Elson G J Becker M H Wholey K O Ehrman 《Journal of vascular and interventional radiology : JVIR》1991,2(2):215-223
Palmaz balloon-expandable intraluminal stents (BEISs) were used to treat vena caval and adjacent central venous obstructions that failed to respond to conventional balloon angioplasty. An initial series included seven patients: five had superior vena cava (SVC) syndrome due to a malignant neoplasm and/or radiation therapy, one had dialysis access-related stenosis of the subclavian vein, and one had inferior vena cava (IVC) and bilateral common iliac vein obstruction due to abdominopelvic radiation therapy for Hodgkin disease. Treatment produced clinical benefit in all seven patients. Patency was achieved with stents placed across stenoses of the SVC, IVC, and brachiocephalic and subclavian veins. One stent placed in a left common iliac vein was oval and was shown to be occluded on a follow-up computed tomographic scan, suggesting that compression between the right common iliac artery and the spine was responsible. Although caution is recommended in placement at possible compression sites, BEISs can be used to treat obstructions of the vena cava and major central veins. 相似文献
20.
Gomez-Jorge J Venbrux AC Magee C 《Journal of vascular and interventional radiology : JVIR》2000,11(7):931-936
PURPOSE: To develop a system for potential use in the treatment of chronic venous insufficiency by using percutaneous techniques. MATERIALS AND METHODS: A segment of a glutaraldehyde-fixed bovine external jugular vein with valves was trimmed and sutured to a nitinol stent. Animals were premedicated and anesthetized (n = 11). Venography of the right external jugular vein, inferior vena cava (IVC), and common iliac vein was performed. Deployment was accomplished via a sheath (12-24 F) with use of fluoroscopic guidance. Eleven bioprostheses were deployed in 11 animals. Bioprostheses were deployed in the IVC (n = 3) or right external iliac vein (n = 6). Animals were killed immediately after deployment (n = 7) at 1 week (n = 1) or at 2 weeks (n = 2). One animal was found dead in the cage. At necropsy, each bioprosthesis (n = 4) was explanted and histopathologic analysis was performed. RESULTS: Deployments of the bioprostheses were successful in nine of 11 swine. Two deployments were unsuccessful (one accidental deployment in the right renal vein, one deployment in the IVC caused rupture of the vein). Postdeployment venography (n = 9) confirmed no reflux (in the recumbent position of the swine) of the valve leaflets and patency of the vein inferior to the level of the bioprostheses. in the first group of animals (n = 5), valve leaflets were normal and competent. In the survival animal group (n = 4), the bioprostheses remained patent without evidence of thrombus formation by ascending and descending venography. Gross inspection of the explanted bioprostheses (n = 4) demonstrated grossly normal valves that fully occluded the lumen. Complications included hemarthrosis (n = 1), death (n = 1), and bioprosthesis thrombosis immediately after deployment (n = 1). Histopathologic analysis showed endothelial cells covering the luminal surfaces. The wall of the bioprostheses had granulomatous response and foreign body reaction. Bacterial contamination was noted in one bioprosthesis. CONCLUSIONS: Deployment of a glutaraldehyde-fixed bovine vein sutured to a self-expanding nitinol stent in the swine iliac vein or IVC is technically feasible. Development of a venous bioprosthesis that can be placed percutaneously may have important clinical applications as an endovascular treatment for chronic venous insufficiency when it is due to valvular incompetence. 相似文献