Benign superior vena cava syndrome: Stenting is now the first line of treatment

Rizvi, Adnan Z.; Kalra, Manju; Bjarnason, Haraldur; Bower, Thomas C.; Schleck, Cathy D.; Gloviczki, Péter

doi:10.1016/j.jvs.2007.09.071

Cited by 199 publications

(178 citation statements)

References 26 publications

(23 reference statements)

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“…However, SVC involvement is still more common. 10,11 In this case of MF, we were able to improve the quality of life of our patient and prolong his survival after diagnosing and treating 2 high-grade stenoses-without the need for open surgery. Improvements in stent technology and in our understanding of the disease process are enabling us to lengthen survival and improve quality of life for patients with advanced MF.…”

Section: Discussionmentioning

confidence: 79%

Endovascular Treatment of Bilateral Pulmonary Artery Stenoses and Superior Vena Cava Syndrome in a Patient with Advanced Mediastinal Fibrosis

Valentin¹,

Kuban²,

Ramanathan³

et al. 2016

Texas Heart Institute Journal

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1 In severe cases, it can progress to obstruction of the superior vena cava (SVC), pulmonary vessels, esophagus, or airways. Whereas SVC obstruction is relatively common, pulmonary artery (PA) involvement is less frequently encountered.2 Very few reports of long-term outcomes exist in the medical literature of either SVC or PA stents in this patient population. We discuss a case in which MF resulted in PA and SVC stenoses that were treated endovascularly, with early symptom improvement and 5-year survival with primary patency. Case ReportA 54-year-old man with histoplasmosis presented at our institution with worsening right-sided chest tightness and difficulty sleeping on his right side because of shortness of breath. Three years before this episode, he had developed SVC syndrome from progressive MF that we had successfully treated endovascularly with an SVC stent. Therefore, differential diagnosis for the current episode of dyspnea included restenosis of the SVC stent, pulmonary embolism, pneumonia, and pulmonary hypertension. A computed tomographic angiogram (CTA) revealed high-grade right-PA stenosis caused by continued progression of MF. In addition, imaging revealed near-complete occlusion of the truncus anterior to the right PA. Results of CTA also revealed that the SVC stent remained widely patent.Subsequently, we performed pulmonary arteriography to evaluate right-PA stenosis and PA hypertension, and to judge the possibility of intervention. Using a femoral approach, we advanced a Mott pulmonary catheter over the wire and into the right ventricle. The catheter was next advanced into the main PA, where the pressure was 35/12 mmHg, and then into the left PA-where digital subtraction arteriography revealed no abnormalities. The left main PA pressure was 36/10 mmHg. The catheter was then modified to make it more amenable to entering the stenosed right main PA. We used a 260-cm, modified stiff Glidewire ® (Terumo Medical Corporation; Somerset, NJ), advancing the wire and catheter into the right main PA. Digital subtraction arteriography revealed approximately 75% stenosis at the origin of the right main PA, extending distally 3.6 cm (Fig. 1). A pressure recording obtained distal to the obstruction was 11/5 mmHg (pressure gradient, 22 mmHg). Given the patient's symptoms, imaging findings, and pressure gradient, intervention was judged necessary.

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Section: Discussionmentioning

confidence: 79%

Endovascular Treatment of Bilateral Pulmonary Artery Stenoses and Superior Vena Cava Syndrome in a Patient with Advanced Mediastinal Fibrosis

Valentin¹,

Kuban²,

Ramanathan³

et al. 2016

Texas Heart Institute Journal

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“…2 Benign etiologies have classically been reported to have an incidence of up to 22%, but now comprise up to 40% of cases. 3,4 Although thrombus formation is a relatively common complication of indwelling central venous catheters and pacemakers, 5,6 the development of symptomatic SVC syndrome is rare, with a reported incidence of 0.03 to 0.04%. 7,8 Superior vena cava syndrome caused by thrombus with a superimposed fungal infection is also rare.…”

Section: Discussionmentioning

confidence: 99%

“…once the gold standard diagnostic study, venography is now reserved for defining the anatomy preoperatively and for confirming vessel patency postoperatively in patients with SVC obstruction. 4 Thrombosis of the SVC can be treated conserva- tively with anticoagulation, or with thrombolysis, percutaneous angioplasty (with or without stenting), or surgery. [15][16][17] Although anticoagulation was initially attempted in this patient, the development of symptoms of SVC obstruction, the septic nature of the thrombus, and the development of embolic complications prompted the surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Unusual cause of superior vena cava syndrome diagnosed with transesophageal echocardiography

Barbeito

Bar-Yosef

Lowe

et al. 2008

Can J Anesth/J Can Anesth

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“…Maintenance of long-term assisted patency required multiple reinterventions during the 36-month period. 29,30 SVC stenting for malignancy disease carries an excellent technical success rate of 95% to 100% and primary and secondary patency rates of 85% and 93%, respectively, at 3 months. 31 Clinical relief of symptoms is usually almost immediate within hours to days after successful SVC recanalization.…”

Section: Superior Vena Cava Syndromementioning

confidence: 99%

Venous Interventions

O'Dea

Schainfeld

2014

Circ: Cardiovascular Interventions

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These studies indicate that CDT for DVT achieves more rapid lysis, reduces the incidence of long-term sequelae of DVT, improves quality of life, preserves valvular competence and more completely restores vessel patency as compared with standard anticoagulation or systemic thrombolytic therapy, although at the expense of a higher rate of hemorrhagic complications (see Table 1 summary of CDT trials).

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Benign superior vena cava syndrome: Stenting is now the first line of treatment

Cited by 199 publications

References 26 publications

Endovascular Treatment of Bilateral Pulmonary Artery Stenoses and Superior Vena Cava Syndrome in a Patient with Advanced Mediastinal Fibrosis

Endovascular Treatment of Bilateral Pulmonary Artery Stenoses and Superior Vena Cava Syndrome in a Patient with Advanced Mediastinal Fibrosis

Unusual cause of superior vena cava syndrome diagnosed with transesophageal echocardiography

Venous Interventions

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