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

Background: 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. Case Summary: 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. Discussion: 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. Conclusion: 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.