MANAGEMENT OF TOTAL PARENTERAL NUTRITION-RELATED SUPERIOR VENA-CAVA OBSTRUCTION WITH EXPANDABLE METAL STENTS

Catheter-related thrombotic and stenotic obstructions are the second m ost common serious complication of long-term total parenteral nutritio n. Subsequent venous access problems have profound implications becaus e of immediate and long-term requirements of nutrition support. Althou gh improved understanding of pathogenesis has led to improved prophyla xis and treatment of thrombosis, some patients will have refractory ob structions that threaten venous access and lead to severe clinical seq uelae, including superior vena cava (SVC) syndrome. We describe two ca ses of patients with SVC syndrome refractory to anticoagulant, thrombo lytic, and balloon angioplasty therapy, managed successfully with perc utaneous placement of expandable metal stents. A discussion of the cur rent understanding of prophylaxis and treatment of catheter-related th rombosis and the role for interventional measures to restore venous pa tency and avoid permanent venous access problems accompanies the case descriptions.