Endovascular thrombectomy of port-induced superior vena cava syndrome using the INARI FlowTriever device
Skotsimara, Athanasios Katsargyris, Chris Klonaris
Affiliations: 2nd Department of Vascular Surgery, Laiko General Hospital, National and Kapodistrian University of Athens,
Athens, Greece
Superior vena cava (SVC) syndrome is a result of obstruction of blood flow through the SVC, secondary to a thrombus, malignancy, or chest infection. The two predominating causes of SVC syndrome include malignant tumors (around 60% of cases) and thrombosis due to central lines, indwelling catheters, and pacemakers (30%-40% of cases). The cases due to thrombosis are rising due to the increasing usage of indwelling intravenous catheters and pacemakers, placing these patients in hypercoagulopathy. The aim of this study is to report a case of successful endovascular thrombectomy of port-induced superior vena cava syndrome using the INARI FlowTriever system.
A 73-year-old male patient underwent distal gastrectomy due to gastric cancer, post neoadjuvant chemotherapy. On the first postoperative day, the patient presented with diffuse facial and bilateral upper-extremity edema, along with dyspnea and shortness of breath. The patient rapidly presented upper-airway obstruction and was immediately intubated and transferred to the intensive care unit (ICU).
The computed tomography demonstrated complete SVC, right subclavian, and left jugular vein thrombosis, indicating the diagnosis of SVC syndrome. The patient was transferred to the operating theater, where left femoral vein access was gained. The INARI FlowTriever was advanced over the wire to the SVC where multiple aspirations of the thrombus were performed. These aspirations withdrew several fragments of red tissue, indicating a fresh thrombus. Post-thrombectomy venography revealed restoration of antegrade flow with a small degree of residual stenosis, and a Sinus Venous 16 x 120 mm (Optimed) was deployed, followed by balloon angioplasty. The patient was transferred to the ICU with complete resolution of clinical signs, and he was extubated on postoperative day 10.
The FlowTriever system has proven to be a successful alternative treatment for patients with pulmonary embolism (PE). Other studies have also shown success of the FlowTriever system outside the scope of PE, such as this case in the setting of SVC syndrome.
