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Cardiac implantable electronic device implantation rates have increased in recent decades. Venous obstruction of the subclavian, brachiocephalic, or superior vena cava veins represents an important complication of implanted leads. These forms of venous obstruction can result in significant symptoms as well as present a barrier to the implantation of additional device leads. The risk factors for the development of these complications remain poorly understood, and diagnosis relies on clinical recognition and cross-sectional imaging. Anticoagulation remains the mainstay of treatment, and thrombus debulking, lead extraction, venoplasty, and stenting are all important therapeutic interventions. This review provides a multidisciplinary-based approach to the evaluation and management of cardiac implantable electronic device lead-associated venous obstruction. [ABSTRACT FROM AUTHOR]

5 million central venous access lines are placed every year in the United States, and it is a common surgical bedside procedure. We present a case of a central venous catheter placement with port for chemotherapy use, during which a duplication of a superior vena cava was discovered on CTA chest after fluoroscopy could not confirm placement of the guidewire. Due to its potential clinical implications, superior vena cava duplication must be recognized when it occurs. [ABSTRACT FROM AUTHOR]

Superior vena cava syndrome (SVCS) affects approximately 15,000 people annually in the United States. Currently, mediastinal malignancies, primarily small cell lung cancer, account for the majority of cases of SVCS. Iatrogenic causes, predominantly long-term central venous catheters, account for approximately 7% of cases of SVCS, and the incidence is increasing. Historically, SVCS was considered an oncologic emergency that required urgent treatment. It is now evident that SVCS is rarely a true emergency and that treatment may be safely provided in a deliberate fashion to the majority of patients. This article provides an overview of the etiology, presentation, diagnosis, and management of SVCS. [Copyright &y& Elsevier]

Superior vena cava (SVC) syndrome is a well-recognized clinical entity seen with mediastinal malignancies and intraluminal venous thrombosis. The role of recombinant tissue plasminogen activator (rt-PA) in the resolution of SVC syndrome caused by thrombosis in the bone marrow transplant settings has not been described. The authors report a case of SVC syndrome with good clinical response in a 16-year-old female with sickle cell disease undergoing an allogeneic bone marrow transplant (BMT) from her HLA identical sibling. Shortly after her transplant, she was found to have significant facial edema and swelling above the neck. Concomitantly, her renal function deteriorated with progressive elevation of serum urea nitrogen and creatinine levels, requiring the use of continuous veno-venous hemofiltration. An upper extremity venogram showed complete SVC obstruction (type III) with apparent inferior reflux into the azygos system. rt-PA was started at a dose of (0.5 mg/kg/day) for 2 days. There was a dramatic resolution of her symptoms, including significant improvement in renal function with increase in urine output. A repeat venogram showed free flow from the distal tip of the central line consistent with a patent superior vena cava. There was no evidence of any bleeding manifestations with rt-PA. This report highlights the usefulness of rt-PA as a treatment modality for SVC syndrome in the BMT settings. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: A persistent left superior vena cava is found in 0.3–0.5% of the general population and in up to 10% of patients with a congenital cardiac anomaly. It is the most common thoracic venous anomaly and is usually asymptomatic. Being familiar with such anomaly could help clinicians avoid complications during placement of central lines, Swan-Ganz catheters, PICC lines, dialysis catheters, defibrillators, and pacemakers. Case presentation: We describe a case of persistent left superior vena cava that was noted after placement of a central line. Mr JJ is a 41 year old African American man who was hospitalized for evaluation and management of alcoholic necrotizing pancreatitis. He required multiple central lines placements. He was noted to have a persistent left superior vena cava that was not recognized initially and thus lead to an unnecessary extra central line placement. Discussion: This anatomic variant may pose iatrogenic risks if it is not recognized by the clinician. A central catheter that tracks down the left mediastinal border may also be in the descending aorta, internal thoracic vein, superior intercostal vein, pericardiophrenic vein, pleura, pericardium, or mediastinum. Conclusion: Our case is significant because the patient had two extra central venous catheter placements. This case strongly demonstrates the importance of knowing the thoracic venous anomalies. [Copyright &y& Elsevier]

The article provides information concerning the routinely perform isolation of the superior vena cava in every atrial fibrillation patient in the U.S. The rapid evolution of atrial fibrillation (AF) ablation techniques has improved people's knowledge about the mechanisms of AF. The author infers that several studies have proven that right atrial triggers and the right atrial substrate are important for AF initiation and maintenance.