2Saud Abdulaziz Alessa, 2Faisal Khalid Binshaiq, 2Abdulrahman Abdulaziz Almefleh, 1Abdulrahman Rsheed Binswilim, 1Ali Saber Rajih, 1Shaker Awad Alshehri, 1Yousof Abdulrahman Alzahrani

1King Abdulaziz Medical City and Kasch, Riyadh, Saudi Arabia; 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Introduction:

We herein report a case of BCS complicated with inferior vena cava (IVC) and in addition to pre-existing superior vena cava (SVC) stenosis that was managed by a simultaneous IVC/SVC sharp recanalization.

Case Report:

A forty-year-old lady came to the clinic complaining of distended abdomen. She is a known case of antiphospholipid syndrome and systemic lupus erythematosus. Triphasic liver computed tomography showed a heterogeneous liver with nutmeg appearance and attenuation of hepatic veins with caudate hypertrophy. The suprahepatic IVC was completely occluded.  Contrast enhanced CT of the chest showed a chronic complete occlusion of the left brachiocephalic vein with multiple collaterals. SVC was patent with multiple calcific foci of the wall likely related to chronic thrombosis. Through the right femoral access, inferior venacavogram was obtained, which showed suprahepatic IVC complete occlusion. Then, an upper venous access was obtained through the right internal jugular vein.  Followed by a venogram which showed a complete occlusion at the right brachiocephalic vein with extensive collaterals were noted. Sharp recanalization from the jugular access of the brachiocephalic vein/SVC was performed targeting the balloon within the SVC that was advanced from the azygos vein using Chiba needle. This was followed by placing a covered stent graft. Then through the SVC approach, successful recanalization of the IVC was made using Outback re-entery device, the suprahepatic IVC was successfully recanalized followed by placement of a non-covered stent in the same time..

Conclusion(s):

Simultaneous sharp recanalization of the occluded SVC/IVC is safe and feasible with proper planning and experienced operators.