C - Cardiac tamponade

While stent migration is a considerable concern, the worst potential acute complication of SVC interventions includes rupture of the caval wall during venoplasty, filling of the pericardium, and subsequent cardiac tamponade. Because of this, some operators will have the lower anterior chest prepped for these cases to facilitate efficient placement of a pericardial drain if this complication occurs. This is more common with refractory central venous obstructions treated with sharp recanalization techniques or RF wire. It can also occur due to over dilating the SVC during venoplasty.