Cardiac Tamponade after Stenting for Superior Vena Cava Obstruction

Percutaneous transluminal stenting has been well documented in use for the treatment of superior vena cava (SVC) obstruction. It offers relatively safe and rapid alleviation of the symptoms of SVC obstruction due to malignancy compared with other treatment modalities. However, cardiac tamponade after stenting treatment occasionally occurrs. Here, we present a case of 48-year-old female patient with cardiac tamponade after endovascular stenting for malignancy-related SVC syndrome. This patient had facial swelling, headache, dysphagia and dyspnea as the initial presentations. After clinical workup, she had SVC obstruction, due to lung cancer. She received SVC endovascular stenting with an Easy-Wall stent. Three hours after the procedure, she developed cardiac tamponade. An urgent operation confirmed that the protruding pin of the Wall stent had punched through the wall of the SVC and into the aorta, which led to the complication. To avoid this unfortunate result, we suggest that for an obstruction site in the lower half of the SVC, the lower margin of the stent should be placed protruding into the right atrium to get a short free end in the right atrial cavity after stent expansion, so that it will not injury the SVC or the atrial wall after stent expansion. From this case report, we can learn a possible hazard of SVC stenting and propose a technique of stent placement to prevent cardiac tamponade.