Recanalization of occluded right innominate vein in presence of a persistent LeVeen shunt: A vascular access rescue case

Background: Superior vena cava syndrome (SVCs) is a common complication in hemodialysis patients due to central vein occlusions, often caused by prior catheterizations. Management can be challenging. Objective: To describe a successful endovascular approach to managing SVCs caused by right innominate vein (RIV) occlusion in a hemodialysis patient with a non-functional LeVeen shunt. Method: An 80-year-old dialysis patient with upper limb edema and vascular access dysfunction was diagnosed with complete RIV occlusion around a long-standing LeVeen shunt. Recanalization was achieved via a percutaneous approach, including angioplasty and placement of a balloon-expandable covered stent, leaving the LeVeen shunt in situ to reduce risks. Results: The procedure restored venous patency and improved vascular access functionality. Postoperative imaging confirmed excellent stent positioning and reduced venous congestion. At a 6-month follow-up, central vein patency was maintained. Conclusion: Endovascular recanalization is a safe and effective strategy for managing SVCs, even with a retained central venous device. This approach preserved vascular access and ensured successful long-term dialysis, offering insights for treating complex venous occlusions.