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Title: A “Train-Track” Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection

Abstract

This report describes a stenting technique used to anatomically reconstruct superior vena cava (SVC) bifurcation in a patient with benign SVC syndrome. After recanalizing the SVC bifurcation, we exchanged two 0.035-in. wires for two 0.018-in. wires, deployed the SVC stent over these two wires (“train-track” technique), and stented each innominate vein over one wire. However, our decisions to recanalize both innominate veins, use the “buddy-wire” technique for SVC dilation, and dilate the SVC to 16 mm before stent deployment likely contributed to SVC tear, which was managed by resuscitation, SVC stent placement, and pericardial drainage. Here, we describe the steps of the train-track technique, which can be adopted to reconstruct other bifurcations; we also discuss the controversial aspects of this case.

Authors:
; ;  [1]
  1. L10, Cleveland Clinic, Section of Vascular and Interventional Radiology, Imaging Institute (United States)
Publication Date:
OSTI Identifier:
22645249
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 4; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; DRAINAGE; PATIENTS; THERAPY; VASCULAR DISEASES; VEINS; WIRES

Citation Formats

Karuppasamy, Karunakaravel, E-mail: karuppk@ccf.org, Al-Natour, Mohammed, E-mail: mnatour85@msn.com, and Gurajala, Ram Kishore, E-mail: gurajar@ccf.org. A “Train-Track” Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection. United States: N. p., 2017. Web. doi:10.1007/S00270-016-1528-6.
Karuppasamy, Karunakaravel, E-mail: karuppk@ccf.org, Al-Natour, Mohammed, E-mail: mnatour85@msn.com, & Gurajala, Ram Kishore, E-mail: gurajar@ccf.org. A “Train-Track” Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection. United States. doi:10.1007/S00270-016-1528-6.
Karuppasamy, Karunakaravel, E-mail: karuppk@ccf.org, Al-Natour, Mohammed, E-mail: mnatour85@msn.com, and Gurajala, Ram Kishore, E-mail: gurajar@ccf.org. Sat . "A “Train-Track” Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection". United States. doi:10.1007/S00270-016-1528-6.
@article{osti_22645249,
title = {A “Train-Track” Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection},
author = {Karuppasamy, Karunakaravel, E-mail: karuppk@ccf.org and Al-Natour, Mohammed, E-mail: mnatour85@msn.com and Gurajala, Ram Kishore, E-mail: gurajar@ccf.org},
abstractNote = {This report describes a stenting technique used to anatomically reconstruct superior vena cava (SVC) bifurcation in a patient with benign SVC syndrome. After recanalizing the SVC bifurcation, we exchanged two 0.035-in. wires for two 0.018-in. wires, deployed the SVC stent over these two wires (“train-track” technique), and stented each innominate vein over one wire. However, our decisions to recanalize both innominate veins, use the “buddy-wire” technique for SVC dilation, and dilate the SVC to 16 mm before stent deployment likely contributed to SVC tear, which was managed by resuscitation, SVC stent placement, and pericardial drainage. Here, we describe the steps of the train-track technique, which can be adopted to reconstruct other bifurcations; we also discuss the controversial aspects of this case.},
doi = {10.1007/S00270-016-1528-6},
journal = {Cardiovascular and Interventional Radiology},
number = 4,
volume = 40,
place = {United States},
year = {Sat Apr 15 00:00:00 EDT 2017},
month = {Sat Apr 15 00:00:00 EDT 2017}
}