Superior vena cava-to-inferior vena cava bridging stent technique for cavo-atrial junction stenosis: a case series

TL;DR

A new stent technique for treating cavo-atrial junction stenosis is shown to improve symptoms in patients with limited treatment options.

Contribution

The study introduces a durable bridging stent technique for cavo-atrial junction stenosis with long-term follow-up.

Findings

Two patients showed significant symptom improvement with no stent-related adverse events over 30 months.

The bridging stent technique is effective for patients with limited treatment options and complex anatomy.

One patient died post-procedure, highlighting the risks involved despite successful outcomes in others.

Abstract

Endovascular bridging stents are relatively underreported but effective methods to increase the diameter of stenosed segments of the superior and inferior cavo-atrial junction. This case report describes the use of superior to inferior vena cava bridging stents to resolve cavo-atrial junction stenoses in three patients with distinct mediastinal masses.

All patients presented symptomatically with shortness of breath, as well as lower limb oedema, facial and neck swelling, and/or a cough. SVC-to-IVC bridging stents were selected as the appropriate intervention for these patients due to progressive symptoms, a lack of alternatives treatment options, and the anatomical proximity of the stenoses to the right atrium. More than 30-month follow-up showed a durable response in two patients without stent-related adverse events. One patient died 5 days post-procedure of shock of unclear aetiology.

In the two cases with long-term follow-up, patients’ symptoms have significantly improved, showing the effectiveness of this intervention for typically end-of-life patients. Consideration is given to the anatomical intricacies involved in the placement of stents, anticoagulation strategies, as well as the impact on future interventions.

This series highlights the complexity of case management in patients with vena cavae stenosis, as well as the durability of bridging stent placement over a uniquely long follow-up.

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