Cardiac tamponade following endovascular therapy due to acute aorto-caval leakage after superior vena cava stenting in tuberculosis mediastinal fibrosis

Superior vena cava (SVC) syndrome results from impaired venous return to the right atrium. While malignancy is the most common cause, benign etiologies such as mediastinal fibrosis are increasingly recognized. Endovascular therapy is considered the first-line treatment due to its high technical success and rapid symptom relief. We report the case of a 47-year-old woman with tuberculosis-related mediastinal fibrosis presenting with progressive SVC syndrome. She underwent uncomplicated endovascular stenting of the SVC using an uncovered stent. Twelve hours after the procedure, the patient developed acute chest pain and hypotension. Transthoracic echocardiography revealed cardiac tamponade requiring urgent pericardial drainage. Persistent bleeding despite placement of a covered stent prompted further evaluation. Cross-sectional imaging and surgical exploration demonstrated a combined injury of the SVC and the adjacent ascending aorta. Emergency surgical repair under cardiopulmonary bypass achieved hemostasis, with a favorable postoperative outcome. This case highlights a rare and life-threatening complication of SVC stenting in mediastinal fibrosis, characterized by simultaneous venous and arterial injury leading to cardiac tamponade. The rigid fibro-calcific environment in mediastinal fibrosis may increase the risk of vascular rupture during endovascular procedures. Careful technique, including gradual and low-pressure dilatation, and close post-procedural monitoring are essential to minimize such complications.