Alternative surgical procedure for treating superior vena cava syndrome in a hemodialysis patient

Chen L Yao, Zheng L Tan, Ran Tian, Peng Miao, Xin Chen, Zheng Y Yu
Journal of Vascular Access 2018, 19 (4): 401-403

BACKGROUND: The incidence of superior vena cava syndrome has been increasing in hemodialysis patients with the widespread use of dialysis catheters. Although endovascular intervention remains the primary choice for treatment, the long-term patency rate is not optimistic. Occlusive lesions are often encountered that cannot be opened using this intervention. Therefore, we chose to present this case involving a pericardial patch used to reconstruct the superior vena cava in the treatment of catheter-associated chronic superior vena cava occlusion.

METHODS: Here, we report a case of facial swelling and severe bilateral pleural effusion secondary to superior vena cava occlusion in a 41-year-old woman. An endovascular venous intervention was attempted initially but failed. Finally, we adopted a procedure using the pericardium as a patch to reconstruct the superior vena cava, maintaining most of the original anatomical structure.

RESULTS: This patient's facial swelling and bilateral pleural effusion disappeared after the operation. In addition, her symptoms of coughing and dyspnea were relieved. The Brescia-Cimino fistula in her left forearm functioned well.

CONCLUSION: The use of a pericardial patch to reconstruct the superior vena cava is a reliable approach in patients who are not candidates for endovascular treatment.

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