Interventional Angioplasty, a Growing Therapeutic Approach to the Superior Vena Cava Obstruction in the Presence of Hemodialysis Catheters: A Report of Two Cases


1 Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, IR Iran

2 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran


Background: The long-term resistance of indwelling hemodialysis catheters leads to the development
of the superior vena cava (SVC) syndrome due to the obstruction of the dialysis catheters. The
management of these cases needs technically challenging interventional procedures using
balloon inflation or stent implantation at the SVC/right atrium junction. Hereby, we report 2
cases of the SVC syndrome in the setting of hemodialysis catheters which were successfully
treated via interventional angioplasty.
Case Presentation: The first case was a 57-year-old man who was referred to us with facial congestion,
gradual loss of consciousness, and fever. The patient underwent emergent hemodialysis. The
source of the fever was found to be an infected permacath in the left internal jugular vein. He
underwent hemodialysis through a right-sided access catheter. Upon the termination of the
fever, the jugular access was exited and an arteriovenous fistula (AVF) was implanted in the
right arm. After a while, the patient experienced swelling in the right arm. Finally, he
underwent angioplasty on the occluded AVF. On follow-up, the arm swelling had faded
gradually. The second case was a 60-year-old man who was referred to us with a diagnosis of
under-dialysis. On admission, the patient’s permacath was removed and an AVF was implanted
in his right arm to replace a dysfunctional AVF previously inserted in his left arm. After the
maturation of the right arm’s AVF, the patient underwent regular hemodialysis sessions without
complications. After 1 year, under-dialysis occurred again. On venous angiography, a cut-down
venous drainage from the origin of the brachiocephalic vein up to its entry into the right atrium
was seen.
Conclusions: Interventional angioplasty is a therapeutic approach to the SVC obstruction in the
presence of hemodialysis catheters.