Sharp recanalization of superior vena cava occlusion with stent migration in a hemodialysis patient: Rescue strategy for life-threatening hemothorax

Abstract

Superior vena cava (SVC) occlusion in hemodialysis patients presents significant therapeutic challenges, particularly when complicated by stent migration. Sharp recanalization may serve as a salvage intervention for refractory cases though high-risk. Here, we present a 72-year-old male with stent migration-induced recurrent SVC syndrome. After failed conventional guidewire recanalization, sharp recanalization was performed with a dual-snare snare-assisted approach. We innovatively performed vertical penetration through the migrated stent. A stent was then vertically deployed within the expanded fenestration. Although SVC patency was successfully restored, the procedure was complicated by massive hemothorax secondary to venous wall laceration. Immediate hemostasis was achieved through emergency deployment of overlapping covered stents. The patient maintained preserved vascular access patency without recurrent symptoms during 6-month follow-up. This case presents an innovative approach of vertical puncture and stent migration to address SVC occlusion, which not only demonstrates the feasibility of sharp recanalization for complex SVC occlusion, but also highlights the critical role of timely endovascular salvage techniques in preventing life-threatening hemorrhagic complications.