Tarek Kammoun: Case of the Day – Superior Vena Cava Thrombectomy
Tarek Kammoun, Hospital Practitioner in Interventional Radiology at Nîmes University Hospital, shared a post on LinkedIn:
“Case of the day – Superior Vena Cava thrombectomy
A challenging case of acute and subacute superior vena cava (SVC) thrombosis related to a totally implanted venous access port in a patient undergoing chemotherapy for colonic cancer.
The patient developed worsening superior vena cava syndrome despite therapeutic anticoagulation. The thrombus had been diagnosed two weeks earlier and the port had previously been removed at another center.
The procedure was performed through:
- Left common femoral venous access – 16F, using a pre-close technique with ProGlide
- Right internal jugular venous access – 4F
As the SVC thrombosis could not be crossed from the femoral approach, a ‘rendezvous’ or through-and-through technique was performed, allowing retrieval of the jugular guidewire with a snare.
A 16F aspiration catheter was then advanced, enabling aspiration of a large amount of recent and subacute thrombotic material.
Final venography demonstrated excellent restoration of SVC patency and flow, with a very good angiographic result.
The patient was maintained on full-dose therapeutic anticoagulation for at least 3 months following the procedure.
I’m sharing the pre- and post-thrombectomy venography images, as well as the large thrombotic burden retrieved.
Intervention carried out with the assistance of Marwen Krouma and Valentin Robert.
Julien Frandon as backup.”
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