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OBJECTIVES To evaluate the technical feasibility and clinical safety of superior vena cava (SVC) filter placement over preexisting central venous lines (CVLs) in 23 patients who had upper extremity deep venous thrombosis with contraindications to anticoagulation. METHODS A retrospective review of the images and electronic medical records of 23 patients from 2008 to 2018 with SVC filters placed over an existing central venous line was performed in a single tertiary medical center. Twenty-one filters were placed over smaller lines (

Peripherally inserted central catheters (PICC) and implantable venous access devices with an attached catheter such as a Port-A-Cath are common types of central venous catheters (CVC) that are used to deliver chemotherapy and other medications. Subclavian vein (SVC) access for CVC, although widely practiced, presents risks for catheter complications such as the compression of the catheter in the space anterior to the first rib and posterior to the clavicle (1). This compression is rated on a scale of grades 0 to 3 pinch-off syndrome (POS). Grade 0 exhibits a regular catheter course without luminal narrowing; grade 1 exhibits an altered catheter course without luminal narrowing; grade 2 exhibits luminal narrowing; and grade 3 exhibits catheter fracture (2). POS may present with pain or swelling of the shoulder region but patients may also be asymptomatic (3). Additionally, POS can be an incidental finding seen on a chest X-ray (4). Regardless, clinicians should suspect a possible POS if there is patient-reported pain or an abnormal catheter pathway seen on a chest X-ray. Further investigation via radiographic or fluoroscopic evaluation is warranted. Early detection of POS requires only catheter replacement but failure to intervene may result in life-threatening complications caused by catheter fragmentation. In such cases, pieces of the catheter may break off to cause ventricular tachycardia, vessel embolization, and cardiac perforation (5-7). In this report, we discuss two cases of grade 3 POS that were detected based on clinical and radiographic signs.

Autogenous arteriovenous vascular access with an arteriovenous fistula (AVF) is the gold standard for attaining long-term hemodialysis vascular access (1). When compared to prosthetic arteriovenous grafts (AVGs) and tunneled hemodialysis catheters, an AVF has less frequent rates of thrombosis, stenosis, and infection.

Catheter-directed thrombolysis (CDT) for the treatment of acute pulmonary embolism (PE) has gained popularity in recent years, but potential complications during the procedure and their management are not frequently discussed in the literature. In this case report, we describe the clinical dilemma regarding the postoperative anticoagulation management of a 60-year-old male who developed cardiac perforation during a CDT of an acute saddle PE. Early resumption of systemic heparin in such cases may help in clot resolution; however, it can worsen the hemopericardium. On the other hand, delaying restarting heparin may help in healing of the cardiac perforation but can lead to clot propagation. As the chest tube output was minimal initially, anticoagulation was started, which, however, led to disastrous outcome. With limited published medical literature to help guide such a complex situation, it may be prudent to carefully weigh the risks and benefits of resuming systemic heparin versus delaying it for 1–2 days to allow for definitive resolution of the cardiac perforation.