Endovascular Treatment for Upper Body Central Venous Obstruction

Endovascular treatment, such as catheter-directed thrombolysis, thrombectomy, balloon angioplasty, and metallic stent placement, is performed for symptomatic upper body central venous obstruction caused by both malignant and benign etiologies. In particular, metallic stent placement should be performed in emergent situations for malignant superior vena cava syndrome presenting with cerebral or laryngeal edema. In malignant cases, the obstruction is usually traversed via the femoral vein. When it fails, an additional trial via the brachial or internal jugular vein is performed, and if necessary, through-and-through access is established. In benign chronic obstructions that cannot be crossed by conventional techniques, sharp recanalization techniques are salvage options. The procedures are relatively safe; however, major complications such as acute pulmonary edema, cardiac tamponade, pulmonary embolism, and stent migration should be warned.