Interventional Angioplasty, a Growing Therapeutic Approach to the Superior Vena Cava Obstruction in the Presence of Hemodialysis Catheters: A Report of Two Cases

Abstract

Background: The long-term resistance of indwelling hemodialysis catheters leads to the development of the superior vena cava (SVC) syndrome due to the obstruction of the dialysis catheters. The management of these cases needs technically challenging interventional procedures using balloon inflation or stent implantation at the SVC/right atrium junction. Hereby, we report 2 cases of the SVC syndrome in the setting of hemodialysis catheters which were successfully treated via interventional angioplasty. Case Presentation: The first case was a 57-year-old man who was referred to us with facial congestion, gradual loss of consciousness, and fever. The patient underwent emergent hemodialysis. The source of the fever was found to be an infected permacath in the left internal jugular vein. He underwent hemodialysis through a right-sided access catheter. Upon the termination of the fever, the jugular access was exited and an arteriovenous fistula (AVF) was implanted in the right arm. After a while, the patient experienced swelling in the right arm. Finally, he underwent angioplasty on the occluded AVF. On follow-up, the arm swelling had faded gradually. The second case was a 60-year-old man who was referred to us with a diagnosis of under-dialysis. On admission, the patient's permacath was removed and an AVF was implanted in his right arm to replace a dysfunctional AVF previously inserted in his left arm. After the maturation of the right arm's AVF, the patient underwent regular hemodialysis sessions without complications. After 1 year, under-dialysis occurred again. On venous angiography, a cut-down venous drainage from the origin of the brachiocephalic vein up to its entry into the right atrium was seen. Conclusions: Interventional angioplasty is a therapeutic approach to the SVC obstruction in the presence of hemodialysis catheters.