Superior vena cava recanalization

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
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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	Assess extent of airway edema Evaluate tolerance for lying flat Review imaging for the presence of an anterior mediastinal mass
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

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

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

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications