TECHNIQUE: Following informed consent and verification of the correct patient identity and planned procedure, the right neck and chest was prepped and draped using sterile technique. The heparin was aspirated through each lumen and discarded. Local anesthesia around the catheter was achieved using 2% Lidocaine. Through each lumen, a 035 Stiff Terumo wire was introduced and advanced to the IVC. The catheter cuff was then freed from the surrounding tissues using a combination of blunt and sharp dissection. The catheter was retracted into the proximal right cephalic vein, and venography was performed.
Review of the images revealed a fibrin sheath involving the entire length of the catheter including the superior vena cava. This resulted in severe narrowing of the SVC. The decision was made to disrupt the fibrin sheath. Over a wire the catheter was removed and a 12 mm x 4 cm angioplasty balloon was advanced into the SVC, and was inflated along the entire length of the SVC and right cephalic vein. Follow-up venography revealed a good venographic result.
Subsequently, over the wires, and new 14.5FR Palindrome catheter (23cm tip to cuff) was introduced until the tip was positioned in the upper right atrium. Following placement, the catheter flushed freely and the catheter course was normal fluoroscopically. The catheter was sutured to the skin using 2-0 Ethilon.
INTERPRETATION:
1. Large fibrin sheath occupying the majority of the superior vena cava, and surrounding the entire catheter, successfully treated with balloon angioplasty as described.
2. Successful over the wire exchange of the right chest 14.5FR Palindrome catheter (23cm tip to cuff).
3. The catheter may be used immediately.
4. Sutures may be removed in 3-4 weeks.
Review of the images revealed a fibrin sheath involving the entire length of the catheter including the superior vena cava. This resulted in severe narrowing of the SVC. The decision was made to disrupt the fibrin sheath. Over a wire the catheter was removed and a 12 mm x 4 cm angioplasty balloon was advanced into the SVC, and was inflated along the entire length of the SVC and right cephalic vein. Follow-up venography revealed a good venographic result.
Subsequently, over the wires, and new 14.5FR Palindrome catheter (23cm tip to cuff) was introduced until the tip was positioned in the upper right atrium. Following placement, the catheter flushed freely and the catheter course was normal fluoroscopically. The catheter was sutured to the skin using 2-0 Ethilon.
INTERPRETATION:
1. Large fibrin sheath occupying the majority of the superior vena cava, and surrounding the entire catheter, successfully treated with balloon angioplasty as described.
2. Successful over the wire exchange of the right chest 14.5FR Palindrome catheter (23cm tip to cuff).
3. The catheter may be used immediately.
4. Sutures may be removed in 3-4 weeks.