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

• Published in: Cardiovascular and interventional radiology 2017-04, Vol.40 (4), p.629-633
• Main Authors: Karuppasamy, Karunakaravel, Al-Natour, Mohammed, Gurajala, Ram Kishore
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon - methods; BIOMEDICAL RADIOGRAPHY; Cardiac Tamponade - complications; Cardiac Tamponade - surgery; Cardiology; Case Report; DRAINAGE; Endovascular Procedures - methods; Female; Humans; Imaging; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; PATIENTS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Stents; Superior Vena Cava Syndrome - complications; Superior Vena Cava Syndrome - surgery; Superior Vena Cava Syndrome - therapy; THERAPY; Ultrasound; VASCULAR DISEASES; VEINS; Vena Cava, Superior - surgery; WIRES
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-016-1528-6

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.