Difference between revisions of "Superior vena cava recanalization"
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Chris Rishel (talk | contribs) Tag: 2017 source edit |
Chris Rishel (talk | contribs) Tag: 2017 source edit |
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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 48: | Line 49: | ||
* CBC | * CBC | ||
* Coagulation panel | * Coagulation panel | ||
* Consider CT chest to evaluate for anterior mediastinal mass | |||
* Consider TTE if concern for intracardiac thrombus | * Consider TTE if concern for intracardiac thrombus | ||
* Consider upper/lower extremity ultrasound with doppler if concern for DVT | * Consider upper/lower extremity ultrasound with doppler if concern for DVT | ||
| Line 63: | Line 65: | ||
*Review chest imaging for the presence of an anterior mediastinal mass | *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. -->=== | ||
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