AngioJetTM rheolytic thrombectomy with covered balloon-expandable stent deployment in a superior vena cava syndrome: a case report


Submitted: 15 October 2023
Accepted: 22 November 2023
Published: 30 November 2023
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The Superior Vena Cava Syndrome (SVCS) is a rare mediastinal syndrome, frequently due to compression by a mediastinal malignant leading to venous flow obstruction through the Superior Vena Cava (SVC) towards the heart. The symptoms may consist of edema of the upper body and distended veins, dyspnea up to a life-threatening condition. Restoring the SVC flow by endovascular means can be beneficial in order to achieve a rapid relief of the clinical symptoms. A 51-year-old male with a recent diagnosis of squamous cell lung tumor diagnosis presented to the emergency department with persistent cough, neck and face swelling, and distended jugular veins on clinical examination. No dyspnea and normal vital parameters were reported. Computed Tomography angiography examination demonstrated thrombosis of subclavian veins and SVC due to compression by malignancy. Compression also involved the right upper lobar bronchus. Through a percutaneous transvenous right humeral access, phlebography confirmed total occlusion of the right subclavian vein, brachiocephalic venous trunk, and superior vena cava. We performed AngioJetTM (Boston Scientific, Marlborough, MA, USA) rheolytic endovascular thrombectomy. The phlebography demonstrated the unlying hemodynamic stenosis due to the ab-extrinsic compression and underwent stenting with a covered balloon-expandable stent. The final phlebography confirmed the patency of the stent and restoration of venous flow. Although there was a complete recovery of the symptoms, the patient died from respiratory complications caused by malignancy involvement. AngioJetTM mechanical thrombectomy and covered balloon-expandable stent deployment is a useful solution for SVCS to quickly achieve relief of the clinical symptoms. There are few case series where thrombectomy and primary stent placement are studied. Further follow-up studies are needed to understand the patency of treated vessels better.


Lauten A, Strauch J, Jung C, et al. Endovascular treatment of superior vena cava syndrome by percutaneous venoplasty. Heart Lung Circ. 2010;19:681-3. DOI: https://doi.org/10.1016/j.hlc.2010.07.007

Abner A. Approach to the patient who presents with superior vena cava obstruction. Chest. 1993;103:394S-397S. DOI: https://doi.org/10.1378/chest.103.4_Supplement.394S

AngioJetTM peripheral thrombectomy system instruction for use, Boston Scientific World Headquarters (Marlborough, MA 01752-1234). Available from: https://www.bostonscientific.com/en-US/products/thrombectomy-systems/angiojet-thrombectomy-system.html.

Agha RA, Franchi T, Sohrabi C, et al. The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines. Int J Surg. 2020;84:226-30. DOI: https://doi.org/10.1016/j.ijsu.2020.10.034

Advanta V12TM covered balloon-expandable stent (Getinge AB, Göteborg, Sweden) instruction for use, https://www.getinge.com/int/products/advanta-v12-balloon-expandable-covered-stent.

Ramjit A, Chen J, Konner M, Landau E, Ahmad N. Treatment of superior vena cava syndrome using AngioJet™ thrombectomy system. CVIR Endovasc. 2019 Aug 14;2(1):28. doi: 10.1186/s42155-019-0071-3. PMID: 32026107; PMCID: PMC6966412. DOI: https://doi.org/10.1186/s42155-019-0071-3

Kalra M, Sen I, Gloviczki P. Endovenous and Operative Treatment of Superior Vena Cava Syndrome. Surg Clin North Am. 2018 Apr;98(2):321-335. doi: 10.1016/j.suc.2017.11.013. PMID: 29502774. DOI: https://doi.org/10.1016/j.suc.2017.11.013

Léon D, Rao S, Huang S, Sheth R, Yevich S, Ahrar K, Huynh T, Pisimisis G, Kuban JD. Literature Review of Percutaneous Stenting for Palliative Treatment of Malignant Superior Vena Cava Syndrome (SVCS). Acad Radiol. 2022 Apr;29 Suppl 4:S110-S120. doi: 10.1016/j.acra.2021.08.016. Epub 2021 Oct 1. PMID: 34602363. DOI: https://doi.org/10.1016/j.acra.2021.08.016

Kee ST, Kinoshita L, Razavi MK, Nyman UR, Semba CP, Dake MD. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement. Radiology. 1998 Jan;206(1):187-93. doi: 10.1148/radiology.206.1.9423671. PMID: 9423671. DOI: https://doi.org/10.1148/radiology.206.1.9423671

Emsley R, Haller C, Arts L. Catheter-directed thrombectomy with the JETi8 in the treatment of acute superior vena cava syndrome. J Vasc Surg Cases Innov Tech. 2022 Aug 5;8(3):545-548. doi: 10.1016/j.jvscit.2022.07.009. PMID: 36081742; PMCID: PMC9445904. DOI: https://doi.org/10.1016/j.jvscit.2022.07.009

Yalcin M, Godekmerdan Katırcıoglu E, Erkoc K and Tiryakioglu O. Preliminary results of pharmacomechanical thrombectomy for iliofemoral deep venous thrombosis: A single center experience. Veins and Lymphatics. 7, 1, Oct 2018). doi:https://doi.org/10.4081/vl.2018.7513. DOI: https://doi.org/10.4081/vl.2018.7513

Petronio AS, Bellini F, De Carlo M (2010) Rheolytic thrombectomy: any role left? Interv Cardiol 2(1):57–65. DOI: https://doi.org/10.2217/ica.09.41

Massi I, Zamboni P. What are the ideal characteristics of a venous stent? Veins and Lymphatics, 10(1), Jun 2021. https://doi.org/10.4081/vl.2021.9739 DOI: https://doi.org/10.4081/vl.2021.9739

Jayaraj A, Raju S. Stenting for obstructive iliac vein lesions. Veins and Lymphatics, 6(1), Aug 2017. https://doi.org/10.4081/vl.2017.6855 DOI: https://doi.org/10.4081/vl.2017.6855

Edwards RD, Jackson JE. Case report: superior vena caval obstruction treated by thrombolysis, mechanical thrombectomy and metallic stents. Clin Radiol. 1993 Sep;48(3):215-7. doi: 10.1016/s0009-9260(05)80288-0. PMID: 8403773. DOI: https://doi.org/10.1016/S0009-9260(05)80288-0

Jean-Baptiste R, Williams DM, Gemmete JJ. Successful treatment of superior vena cava rupture with placement of a covered stent: a report of two cases. Cardiovasc Intervent Radiol. 2011 Jun;34(3):667-71. doi: 10.1007/s00270-011-0128-8. PMID: 21394562. DOI: https://doi.org/10.1007/s00270-011-0128-8

Gwon DI, Ko GY, Kim JH, Shin JH, Yoon HK, Sung KB. Malignant superior vena cava syndrome: a comparative cohort study of treatment with covered stents versus uncovered stents. Radiology. 2013 Mar;266(3):979-87. doi: 10.1148/radiol.12120517. Epub 2012 Dec 18. PMID: 23249571. DOI: https://doi.org/10.1148/radiol.12120517

Cosacco, A. M., Zenunaj, G., & Traina, L. (2023). AngioJet<sup>TM</sup> rheolytic thrombectomy with covered balloon-expandable stent deployment in a superior vena cava syndrome: a case report. Veins and Lymphatics, 12(1). https://doi.org/10.4081/vl.2023.11992

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