Long-term follow-up of endovascular repair of iatrogenic superior vena cava injury: A case report

RATIONALE: This report aimed to present the long-term follow-up results of the management of superior vena cava (SVC) rupture during balloon angioplasty in an attempt to relieve SVC obstruction as a result of hemodialysis (HD) catheter-related central vein stenosis. PATIENT CONCERNS: We present a case of a 42-year-old woman with end-stage renal disease on HD for 4 years, initially from an autogenous fistula for 2.5 years and then from a right internal jugular vein (IJV) catheter. She presented with clinical manifestations of SVC obstruction (dilated anterior chest wall and abdominal wall veins and facial swelling), which progressed over the last 1.5 years. DIAGNOSIS: A venogram confirmed right and left brachiocephalic vein and SVC obstruction. INTERVENTIONS: She underwent balloon angioplasty of the SVC through the right IJV, during which the dilated area ruptured, resulting in right hemothorax and hypovolemic shock. A covered stent was placed over the bleeding site, and the patient recovered. OUTCOMES: Rapid and skilled endovascular intervention through placement of a covered stent at the bleeding site can be lifesaving. LESSONS: It is superior to open surgical management in terms of complexity and morbidity especially in patients who are poor surgical candidates, and its durability is proving to be comparable.