Superior Vena Cava Decompression After Complicated Stent Placement for Innominate Vein Obstruction in a VVI-ICD Patient

Figures

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  Figure 1. Computed Tomography The computed tomography images show no flow through the cephalic vein, the stent positioned in the left innominate vein (IV) and superior vena cava (SVC) below the stent. The stent is in contact with the lateral wall of the SVC. White arrowheads indicate the obliterated stent inflow and outflow. The 3-dimensional reconstruction highlights the lack of connection between the axillary vein (AV), left internal jugular vein (IJV), and IV. In addition, no collateral drainage is visible through the stent. Collateral vessels are indicated by white arrows.

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  Figure 2. Procedural Steps (A to C) Preprocedural angiographic images confirming flow obstruction in the superior vena cava (SVC) below the stent, along with extensive collateral flow that does not drain into the stent. (D) Ballooning of the stent roof and further into the SVC along the pacing leads with the use of a 12-mm Conquest balloon. (E) Ballooning of the stent lumen with the same 12-mm Conquest balloon, followed by a kissing balloon technique using a 12-mm Conquest balloon in the SVC and an 8-mm Dorado balloon in the stent lumen. (G, H) Restored flow through the SVC down to the right atrium, with collateral flow entering the stent lumen.