Department of Radiology, Division of Vascular and Interventional Radiology, Boston Medical Center, 88 East Newton Street, Boston, MA-02118.
Clin Imaging. 2013 Nov-Dec;37(6):1138-41. doi: 10.1016/j.clinimag.2013.04.008. Epub 2013 Aug 2.
A 68-year-old male with end-stage renal disease, congestive heart failure, and facial and bilateral arm swelling was referred for placement of a tunneled dialysis catheter. Distal left subclavian vein access was obtained. The procedure was complicated by iatrogenic perforation of the superior vena cava (SVC). This resulted in rapid development of a right-sided hemothorax and hemodynamic instability. A right-sided thoracostomy tube was placed to drain the pleural cavity. Extrapericardial perforation of the SVC can be managed conservatively in select cases without endovascular balloon dilatation and/stent graft deployment or surgical repair provided the antegrade blood flow is maintained via patent collateral circulation.
一位 68 岁男性，患有终末期肾病、充血性心力衰竭，伴有面部和双侧手臂肿胀，转来置入隧道式透析导管。获得了左侧锁骨下远端静脉通路。该过程中出现医源性上腔静脉（SVC）穿孔，导致迅速出现右侧血胸和血流动力学不稳定。放置右侧胸腔引流管以排出胸腔。在选择的病例中，如果通过通畅的侧支循环保持前向血流，可以保守治疗 SVC 心包外穿孔，而无需血管内球囊扩张和/或支架移植或手术修复。
