Two patients with superior vena cava syndrome (SVCS) recurring after maximum-tolerance radiation were treated by placing a Gianturco expandable wire stent (GEWS) into the obstructed superior vena cava. The SVCS symptoms rapidly disappeared and good short-term (6 months) palliation was achieved. GEWS placement is a promising therapeutic alternative for palliation of SVCS symptoms when other therapeutic modes cannot be used or are not effective.
Original Gianturco expandable stents and their modifications were used to create an experimental intrahepatic portacaval anastomosis (EIPCA) in 30 young domestic swine without portal hypertension. The study focused on the design of a suitable stent, the technique of its application, and the evaluation of short-term patency of the EIPCA. A stent with a 2.5-cm-long body and wire skirts on both ends was most suitable for EIPCA creation. Well-positioned stents shunted most of the portal blood in the inferior vena cava circulation and remained patent for 4-6 weeks. Ingrowth of liver parenchyma and abundant proliferation of the intima and connective tissue inside the stent lumen in these rapidly growing animals gradually decreased EIPCA patency, and thrombus formation with diminished blood flow closed them completely.
Two patients with superior vena cava syndrome (SVCS) associated with massive thrombosis were treated by means of local thrombolytic therapy and placement of modified Gianturco expandable wire stents. Treatment resulted in complete resolution of the SVCS symptoms. The combination of local thrombolytic therapy and stent placement allows a more aggressive approach to treatment of SVCS and provides longer-term palliation of symptoms even for patients with later stages of the disease.
Gianturco expandable wire stents are cylindrical wire structures 0.5-3.5 cm in diameter that can be used to dilate narrowed vascular or ductal lumina [1 -4]. Made of stainless steel wire that is bent in a zigzag pattern, the stents are introduced in a compressed form through relatively small (8-1 2 French) catheters.After release, they expand inside a vessel or duct, dilating the narrowed lumen. We have modified the original design to control expansion of the stents, facilitate their placement, and prevent their dislodgment.
Materials and MethodsThe modified Gianturco expandable wire stents are made by hand in our research
A new coaxial needle-catheter system was designed for transjugular portal vein puncture in young domestic swine. It was tested in 32 animals and successfully entered the portal circulation via a hepatic vein or intrahepatic portion of the inferior vena cava. No complications were encountered.
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