A Case of Superior Vena Cava Syndrome Secondary to a Tunneled Dialysis Catheter

Introduction: Superior vena cava (SVC) syndrome has generally been associated with malignant causes. Central venous occlusion is a known, but rare complication of long term central venous catheters. Here we present a case of SVC syndrome associated with a tunneled dialysis catheter (TDC) in a patient with a failed arteriovenous fistula (AVF). Case Description: 49 year old male with a history of ESRD, Type 1 diabetes, COPD, GERD presented to the ED for evaluation of facial swelling, chest pain, and dyspnea for 2-3 weeks. He has a failed right upper extremity AVF and a left subclavian TDC for access. He had a recent admission to an outside hospital one week prior for similar symptomes, during which an echocardiogram revealed an ejection fraction of 55-60% and stress test showed no cardiac cause for his chest pain. His symptoms worsened after discharge with increased dizziness and syncopal episodes, prompting this hospital visit. Chest xray showed no acute findings, however CT Chest with contrast revealed severely decreased caliber of the SVC with mediastinal collaterals, suspicious for SVC syndrome, no lung masses appreciated. Venogram was performed which revealed total occlusion of the SVC. Vascular surgery performed an angioplasty and replaced the TDC to the left subclavian, with improvement of flow through his SVC. His symptoms resolved and he was discharged with plans for another AVF creation as an outpatient. Discussion: This case highlights a rare case of SVC syndrome secondary to a TDC, and the benefits of AVF creation. While a TDC is an adequate form of HD access, it can have very serious complications, such as SVC syndrome. Moreover, the patient’s diagnosis was missed during his first hospitalization, and therefore highlights the importance of considering SVC syndrome in those with TDC.Thoracic Venogram before and after angioplasty and TDC replacement (A) Thoracic Venogram revealing decreased filling and occlusion of the SVC. (B) Thoracic Venogram after new tunneled catheter placed, showing blood flow in SVC