Catheter-directed thrombectomy combined with angioplasty and stent implantation for superior vena cava syndrome: a case report.

BACKGROUND

Superior vena cava (SVC) syndrome (SVCS) caused by thrombosis in artificial vascular grafts is characterized by high morbidity and mortality, with endovascular treatment being the primary therapeutic approach. In this case report, we present a safe multimodal endovascular treatment protocol that can rapidly alleviate acute SVCS symptoms, combining targeted thrombectomy via a guiding catheter with balloon dilation and Bard venous stent placement. Such combined endovascular therapies remain relatively uncommon in clinical reports.

CASE DESCRIPTION: A 61-year-old female with a 10-year history of mediastinal nodules was admitted to hospital for recurrent dizziness. Via computed tomography (CT), she was diagnosed with a malignant thymic tumor invading the SVC and subsequently underwent sternotomy via a video-assisted thoracoscopic approach for tumor resection and SVC reconstruction with an 8-mm expanded polytetrafluoroethylene (e-PTFE) graft. Postoperatively, she developed SVCS (upper extremity/chest wall swelling, cyanosis) due to graft occlusion. Emergency treatment included 8F guiding catheter thrombectomy, sequential balloon dilatation, and Bard venous stenting, which resolved the stenosis. She received anticoagulants (low-molecular-weight heparin and subsequent rivaroxaban) and had no thrombosis at follow-up in August 2024.

CONCLUSIONS

The combination of guiding catheter thrombectomy, balloon dilatation, and Bard stent implantation is feasible, safe, and effective for e-PTFE graft-associated SVCS, relieving symptoms quickly and avoiding reoperation. This approach can benefit patients unsuited to surgery, but they should be monitored closely for adverse hemodynamic events after stenting. Further studies are needed to validate the efficacy of this method.