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• W4387268701 abstract "SESSION TITLE: Procedures Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Superior vena cava syndrome (SVCS) is a rare complication of malignancy that occurs when the superior vena cava (SVC) is obstructed. The obstruction can be caused by a variety of factors, including tumors, thrombosis, or inflammation. The incidence of SVCS due to malignancy is estimated to be between 3-10% of all SCVS cases. We present a patient with signs and symptoms of SVCS secondary to metastatic lung cancer and our unique approach to relieve her obstruction. CASE PRESENTATION: A 65-year-old female with past medical history of stage IV lung cancer with metastasis to the brain and liver, presented to our emergency room with worsening facial swelling for three days. CTA revealed a subtotal thrombosed SVC and a right suprahilar mass inseparable from the right paratracheal space compatible with malignancy and compression of the right upper lobe pulmonary artery. Interventional cardiology was consulted for removal of the thrombus causing SCVS. Access was obtained in the right internal jugular and right femoral vein with a goose snare grabbing the right internal jugular wire. Afterwards, a microcatheter was introduced through the right internal jugular and exchanged for a Amplatz Super Stiff wire. Subsequently, this system was exchanged for a 20F Inari system with removal or large clot burden. Intravascular Ultrasound (IVUS) was then introduced which showed significant narrowing of the SVC with significant attachment to the lumen and likely tumor invading the SVC. Balloon angioplasty with two 6.0 x 150 mm drug coated balloons were deployed with a kissing technique in the SVC (above and below). Repeat intravascular ultrasound showed improvement of flow. A Medtronic venous self-expanding stent of 18 x 80 mm was deployed in the SVC. Final angiography showed significant improvement flow into the right atrium. The patient tolerated the procedure well with drastic improvements in facial swelling. DISCUSSION: Stenting of the SVC is a medical procedure that uses imaging guidance to restore blood flow in patients with SVC obstruction. The stent is inserted through the internal jugular, subclavian, or common femoral vein under local anesthesia. A guide wire is used to navigate through the blockage and position the stent. The procedure restores flow and alleviates congestion and associated symptoms. The National Institute for Health and Clinical Excellence (NICE) has approved this procedure as an accepted treatment with low complication rates and high success rates. CONCLUSIONS: In this case report, we presented a 65-year-old female with Superior Vena Cava Syndrome (SVCS) secondary to metastatic lung cancer, who was successfully treated with a unique interventional approach involving balloon angioplasty and stenting of the SVC. The stenting procedure demonstrated its effectiveness in rapidly relieving the patient's symptoms, improving blood flow, and reducing the obstruction. As supported by NICE guidelines, stenting of the SVC is an accepted treatment with low complication rates and high success rates. This case serves as a valuable example of the role of interventional cardiology in managing complex vascular complications related to malignancy and emphasizes the need for a multidisciplinary approach to optimize patient outcomes. REFERENCE #1: Overview: Stent Placement for Vena Caval Obstruction: Guidance. NICE, https://www.nice.org.uk/guidance/ipg79. DISCLOSURES: No relevant relationships by Fernando Carreras Calvo No relevant relationships by Alejandro Dominguez No relevant relationships by Magnie Ledesma Leon No relevant relationships by Guillermo Loyola No relevant relationships by Marquand Patton" @default.
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• W4387268701 date "2023-10-01" @default.
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• W4387268701 title "UNIQUE APPROACH TO ENDOVASCULAR STENTING TO TREAT SUPERIOR VENA CAVA OBSTRUCTION" @default.
• W4387268701 doi "https://doi.org/10.1016/j.chest.2023.07.3530" @default.
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