Endovascular Stenting as a Treatment for Brachiocephalic Venous Malformation
Figure legend
1A: Contrast-enhanced, three-dimensional MR venography demonstrating the malformation of the right, and the high grade stenosis of the left, brachiocephalic vein. Cephalic venous drainage was mainly achieved via an extensive cervical and thoracic paravertebral plexus and the dilated azygos vein. BCV, brachiocephalic vein; SVC superior vena cava; RV, right ventricle.
1B, C: Pre-interventional X-ray venography confirming the findings of MR imaging. BCV, brachiocephalic vein; SVC superior vena cava
1D: X-ray venography at 3 months follow-up demonstrating patency of the stent.
M. Roser, I. Paetsch, C. Butter
Department of Internal Medicine, German Heart Institute Berlin, Germany
A 33-year-old woman was referred with severe upper venous congestion, exercise-induced swelling of both arms and dyspnoea which had developed over a 12-month period.
The history of the patient was inconspicuous; routine laboratory parameters, the screening for genetic coagulation disorders, as well as systemic diseases, showed no pathologic findings. No cardiac pathology was found during echocardiography. Remarkably, computed tomography demonstrated non-existence of the right brachiocephalic vein and extensive venous collateralization of the thorax without any hint of a primary or secondary malignant process. Contrast-enhanced, three-dimensional Magnetic resonance (MR) venography showed a high-grade stenosis of the left brachiocephalic vein (BCV, panel 1A).
Conventional X-ray venography confirmed these findings (panel 1B, C) and endovascular stenting of the left BCV was performed successfully.
The patient was discharged on oral anticoagulation. X-ray venography at 3 months follow up showed an excellent angiographic result (panel 1D). The patient is fine after 2 years of follow-up. We hypothesize that idiopathic malformation of the right BCV became apparent with left BCV stenosis leading to reduced cephalic drainage via a hyperplastic paravertebral plexus.
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