Superior vena cava-to-inferior vena cava bridging stent technique for cavo-atrial junction stenosis: a case series

Endovascular bridging stents are relatively underreported but effective methods to increase the diameter of stenosed segments of the superior and inferior cavo-atrial junction. This case report describes the use of superior to inferior vena cava bridging stents to resolve cavo-atrial junction stenoses in three patients with distinct mediastinal masses.

All patients presented symptomatically with shortness of breath, as well as lower limb oedema, facial and neck swelling, and/or a cough. SVC-to-IVC bridging stents were selected as the appropriate intervention for these patients due to progressive symptoms, a lack of alternatives treatment options, and the anatomical proximity of the stenoses to the right atrium. More than 30-month follow-up showed a durable response in two patients without stent-related adverse events. One patient died 5 days post-procedure of shock of unclear aetiology.

In the two cases with long-term follow-up, patients’ symptoms have significantly improved, showing the effectiveness of this intervention for typically end-of-life patients. Consideration is given to the anatomical intricacies involved in the placement of stents, anticoagulation strategies, as well as the impact on future interventions.

This series highlights the complexity of case management in patients with vena cavae stenosis, as well as the durability of bridging stent placement over a uniquely long follow-up.