Difference between revisions of "Superior vena cava recanalization"
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==Overview== | ==Overview== | ||
===Indications=== | ===Indications=== | ||
Superior vena cava recanalization is performed to restore normal venous drainage of the SVC and relieve symptoms of SVC syndrome. | |||
===Surgical procedure=== | ===Surgical procedure=== | ||
The procedure is typically performed via sheath access through a femoral vein. | The procedure is typically performed via sheath access through a femoral vein. | ||
| Line 25: | Line 26: | ||
|Airway | |Airway | ||
| | | | ||
* | * Assess extent of airway edema | ||
* Evaluate imaging for the presence of an anterior mediastinal mass | * Evaluate tolerance for lying flat | ||
* Review imaging for the presence of an anterior mediastinal mass | |||
|- | |- | ||
|Neurologic | |Neurologic | ||
| | |Neuro exam to evaluate for deficits if cerebral perfusion pressure decreased | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| Line 35: | Line 37: | ||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
| | | | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | |Patients may be hypercoagulable | ||
|- | |- | ||
|Other | |Other | ||
| Line 53: | Line 46: | ||
|} | |} | ||
===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ||
* CMP | |||
* CBC | |||
* Coagulation panel | |||
* Consider CT chest to evaluate for anterior mediastinal mass | |||
* Consider TTE if concern for intracardiac thrombus | |||
* Consider upper/lower extremity ultrasound with doppler if concern for DVT | |||
===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->=== | ===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->=== | ||
===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->=== | ===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->=== | ||
==Intraoperative management== | ==Intraoperative management== | ||
===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->=== | ===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->=== | ||
* Large vessel clots may make reliable peripheral IV access challenging | |||
** Consider ephedrine test dose to determine circulation time | |||
** May require central access in vessel with no thrombus | |||
===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->=== | ===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->=== | ||
*Thorough airway evaluation is '''critical''' | |||
*Significant airway edema is common | |||
*Review chest imaging for the presence of an anterior mediastinal mass | |||
===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | ===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | ||
*Supine | |||
===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->=== | ===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->=== | ||
| Line 70: | Line 72: | ||
==Postoperative management== | ==Postoperative management== | ||
===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ||
*Patients are typically positioned with the head of the bed at least 30° to facilitate venous drainage | |||
===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ||
*Minimal postoperative pain is expected | |||
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ||
| Line 115: | Line 117: | ||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
[[Category:Interventional radiology]] | |||
Latest revision as of 09:50, 10 August 2022
Superior vena cava recanalization
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access | |
| Monitors |
Standard ASA Art line |
| Primary anesthetic considerations | |
| Preoperative |
Airway edema Potential mediastinal mass |
| Intraoperative |
Major vessel injury Pulmonary embolus |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A superior vena cava recanalization is an interventional radiology procedure performed to treat superior vena cava syndrome.
Overview
Indications
Superior vena cava recanalization is performed to restore normal venous drainage of the SVC and relieve symptoms of SVC syndrome.
Surgical procedure
The procedure is typically performed via sheath access through a femoral vein.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway |
|
| Neurologic | Neuro exam to evaluate for deficits if cerebral perfusion pressure decreased |
| Cardiovascular | |
| Pulmonary | |
| Hematologic | Patients may be hypercoagulable |
| Other |
Labs and studies
- CMP
- CBC
- Coagulation panel
- Consider CT chest to evaluate for anterior mediastinal mass
- Consider TTE if concern for intracardiac thrombus
- Consider upper/lower extremity ultrasound with doppler if concern for DVT
Operating room setup
Patient preparation and premedication
Intraoperative management
Monitoring and access
- Large vessel clots may make reliable peripheral IV access challenging
- Consider ephedrine test dose to determine circulation time
- May require central access in vessel with no thrombus
Induction and airway management
- Thorough airway evaluation is critical
- Significant airway edema is common
- Review chest imaging for the presence of an anterior mediastinal mass
Positioning
- Supine
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
- Patients are typically positioned with the head of the bed at least 30° to facilitate venous drainage
Pain management
- Minimal postoperative pain is expected
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Chris Rishel