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Resolution Of Superior Vena Cava Syndrome With The Inari Flowtriever
Omodele Durojaye, MD, MA, Maham Rahimi, MD.
Houston Methodist Hospital, Houston, TX, USA.
DEMOGRAPHICS: Superior vena cava syndrome (SVCS) is a rare thoracic central venous obstruction, with about 15,000 U.S. cases annually. Roughly 30% are caused by central venous catheters, with rising incidence due to increased catheter use. Endovascular management typically involves thrombolysis, balloon angioplasty and stenting, but aspiration thrombectomy is less common. The Inari FlowTriever, an FDA-approved large-bore mechanical thrombectomy device for venous thrombosis, is well-documented in lower extremity veins but rarely used for thoracic or upper extremity veins.
HISTORY: A 57-year-old woman with Type I Gaucher’s disease, receiving enzyme replacement via a left subclavian venous catheter placed five years prior, presented with swelling of the face, upper chest, and extremities, along with shortness of breath. CT revealed extensive thrombosis in bilateral jugular, brachiocephalic, and subclavian veins, with near-complete occlusion of the superior vena cava (SVC). She was transferred to our hospital for higher level care management of her headaches and shortness of breath.
PLAN: The patient was placed on intravenous heparin and underwent suction thrombectomy via a 20Fr Inari FlowTriever catheter. Thrombectomy of the SVC and bilateral jugular, brachiocephalic, and subclavian veins was successful, though residual SVC stenosis remained, prompting balloon angioplasty with resolution of stenosis. Postoperative day 1, swelling and discoloration resolved, and she was discharged on anticoagulation. At one month and a year follow-up, the patient had full symptom resolution.
DISCUSSION: Large-bore mechanical thrombectomy can effectively manage severe SVCS with extensive thoracic venous thrombosis.
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