Recanalization of the right brachiocephalic vein for treatment of gastroesophageal reflux disease caused by superior vena cava syndrome

Superior vena cava syndrome (SVCS) is caused by obstruction of blood flow in the SVC or brachiocephalic vein. Malignant occlusion or compression is the most common cause of SVCS.1Morriello F. Brown A. Granton J. Bonta M. Catheter-associated superior vena cava syndrome.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2023; 195: E72-e75Crossref Scopus (2) Google Scholar In recent years, the incidence of hemodialysis-related SVCS has increased.2Zhao Q.Y. Li Q. Cui T.L. Risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome.J Vasc Surg Venous Lymphat Disord. 2024; 12101682Google Scholar SVCS can lead to facial and upper extremity edema, dyspnea, and gastrointestinal bleeding.3Yu J.B. Wilson L.D. Detterbeck F.C. Superior vena cava syndrome--a proposed classification system and algorithm for management.Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2008; 3: 811-814Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Additionally, SVCS can result in proximal esophageal varices,4Khan A.A. Turki M. Frandah W. An Unusual Case of Hematemesis.Gastroenterology. 2023; 165: e8-e10Abstract Full Text Full Text PDF Google Scholar which may lead to symptoms like dysphagia, acid regurgitation, and heartburn. Here we report a rare case of recanalization of the right brachiocephalic vein (RBV) for the treatment of gastroesophageal reflux disease caused by SVCS. A 42-year-old male presented to our hospital with facial and neck edema accompanied by acid reflux, and heartburn for the past 3 months. The patient had been undergoing hemodialysis via a left upper extremity arteriovenous fistula for 7 years. The chest 3-dimensional imaging disclosed severe stenosis of SVC and complete occlusion of bilateral brachiocephalic veins (Figure A). The chest computed tomography angiography showed esophageal varices caused by SVCS (Figure B [red arrow]). Nevertheless, hepatic ultrasonography revealed normal liver parenchymal stiffness and an absence of any prior gastrointestinal disease. The patient's acid reflux and heartburn improved after omeprazole, but his face and neck remained edematous. We used a transhepatic cholangial drainage needle (Cook Incorporated, USA) to percutaneously successfully puncture the RBV and SVC after failed guidewire and catheter technique (Figure C). The lesions recovered well after 6-mm and 8-mm balloon dilation (Boston Scientific,USA) and stenting (8mmx50mm and 8mmx100mm, Viabahn, W.L. Gore), and no further procedure was performed on the left brachiocephalic vein occlusion because of the formation of collateral circulation and increased procedure risk (Figure D). On the first day after the operation, the patient's facial and neck swelling significantly decreased, and the symptoms of acid reflux and heartburn subsided. At 6, 11, and 17-month post-procedure, the patient re-experienced severe acid reflux and heartburn accompanied by mild facial and cervical edema, which improved markedly each time following 8-mm balloon dilatation of the RBV and SVC lesions under digital subtraction angiography. Currently, 20 months post-operation, the patient remains free of acid reflux, heartburn, and facial or neck edema. We recommend regular follow-up visits and immediate medical consultation should symptoms recur. Figure A as the cover image of the Journal. Patient consent for publication was obtained. JB Sun, Y Liu, ZQ Duan, and TL Cui collected the clinical data. JB Sun, Y Liu, ZQ Duan and TL Cui wrote the manuscript. JB Sun and TL Cui supervised the conceptualization, writing, and review process of the article. All authors read and approved the publication of final manuscript. The authors disclose no conflicts.