1. Superior Vena Cava Syndrome: Role of the Interventionalist
Vamsidhar Rachapalli, MD, Louis-Martin Boucher, MD, PhD 
Canadian Association of Radiologists Journal 
Volume 65, Issue 2, Pages (May 2014)
DOI: /j.carj
Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

2. Figure 1
Stenting of a superior vena cava (SVC) occlusion in a man with non–small cell lung cancer metastasis to the mediastinum. (A) Coronal computed tomography image of the chest, demonstrating a calcified lesion compressing the SVC (arrow). (B) A catheter is advanced from a femoral access, the lesion is crossed, and a venogram is performed, demonstrating an absence of flow in the SVC, with retrograde flow up the left brachiocephalic vein, which is draining into large mediastinal collaterals. (C) Over a wire, stenting is performed by using two 10 × 68-mm Wallstents, which were further angioplastied to 14 mm. (D) A final venogram no longer demonstrates collateral flow and a widely patent SVC. Mean pressure gradient before stenting was 14 mm Hg, which declined to 3 mm Hg after stenting.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

3. Figure 2
Angioplasty of superior vena cava (SVC) stenosis in a man with a long-term indwelling left-sided Hickman catheter who presented with upper extremity congestion. Previous venogram had demonstrated obstruction of the SVC with associated intraluminal filling defects, which were attributed to clots. The patient was anticoagulated, with only mild symptomatic improvement. He returned for further treatment. A basilic venous access is used. (A) A venogram, demonstrating a tight but nonocclusive stenosis at the junction of the brachiocephalic veins and SVC. (B) Over a wire, angioplasty is performed by using a 14-mm balloon. In this case, the catheter was not removed before angioplasty for access-site preservation reasons. However, it most often is, in which case, the access used for the angioplasty is through the tract of the removed catheter. (C) Postangioplasty venogram, demonstrating restoration of SVC luminal calibre, which was associated with immediate subjective improvement in patient symptoms.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

4. Figure 3
Sharp recanalization of obstructed superior vena cava (SVC) secondary to long-term indwelling dialysis line. The dialysis catheter was removed. Access from above was obtained via the old catheter tract. Access from below was obtained via the right common femoral vein. Venograms from above (A) and below (B), demonstrating complete short-segment occlusion of the SVC. Attempt at crossing the occlusion with a wire failed. Over a Mandril wire, the outer core of a 22-gauge Chiba needle is advanced from above to the superior aspect of the occlusion. The wire is then replaced by the inner stylet. (C) A snare is positioned at the inferior edge of the occlusion. Under fluoroscopic guidance, the needle is advanced into the snare. (D) A wire, passed through the needle, is snared, and the tip is pulled out from below so that both ends are exiting the body. (E) Over this wire, the SVC is stented with a 12 × 80-mm Luminexx stent and angioplastied to 12 mm. (F) Poststenting venogram, demonstrating good calibre of the SVC.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
Copyright © 2014 Canadian Association of Radiologists Terms and Conditions