Endovascular Stenting as the First Step in the Overall Management of Malignant Superior Vena Cava Syndrome

Lanciego, Carlos; Pangua, Cristina; Chacón, José Ignacio; Velasco, Javier; Boy, R. Cuena; Viana, Ana Carolina Cavalcante; Cerezo, S.; García, L. Carpio

doi:10.2214/ajr.08.1904

Cited by 106 publications

(94 citation statements)

References 36 publications

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“…37 Technical success was achieved in 99% of patients and clinical success in 91% of patients in the unilateral group, and 90% of patients in the bilateral group, which is similar to other reports. 38 The occlusion rate was significantly lower in the unilateral group than in the bilateral group. The complication rate was higher in the bilateral group (28%) than in the unilateral group (9%).…”

Section: Endovascular Treatmentmentioning

confidence: 84%

Superior Vena Cava Syndrome in Thoracic Malignancies

et al. 2011

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The superior vena cava syndrome (SVCS) comprises various symptoms due to occlusion of the SVC, which can be easily obstructed by pathological conditions (eg, lung cancer, due to the low internal venous pressure within rigid structures of the thorax [trachea, right bronchus, aorta]). The resulting increased venous pressure in the upper body may cause edema of the head, neck, and upper extremities, often associated with cyanosis, plethora, and distended subcutaneous vessels. Despite the often striking clinical presentation, SVCS itself is usually not a life-threatening condition. Currently, randomized controlled trials on many clinically important aspects of SVCS are lacking. This review gives an interdisciplinary overview of the pathophysiology, etiology, clinical manifestations, diagnosis, and treatment of malignant SVCS.

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Section: Endovascular Treatmentmentioning

confidence: 84%

Superior Vena Cava Syndrome in Thoracic Malignancies

et al. 2011

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“…however, approximately 95% of cases are caused by malignant disease [7,8]. SVC obstruction presents with symptoms of congestion and edema in the upper limbs, head, neck, and upper thoracic area, as well as dyspnea, dysphagia, and headache [8].…”

Section: Discussionmentioning

confidence: 99%

“…SVC obstruction presents with symptoms of congestion and edema in the upper limbs, head, neck, and upper thoracic area, as well as dyspnea, dysphagia, and headache [8]. Diagnosis of SVC obstruction is made clinically and confirmed by CT [7,9].…”

Section: Discussionmentioning

confidence: 99%

Hypotension due to compression of the inferior vena cava by intrathoracic herniation of peritoneal fat during laparoscopic surgery - A case report -

et al. 2018

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Vena cava syndrome is a condition presenting with various symptoms caused by central venous obstruction, which can be divided into superior vena cava (SVC) syndrome and inferior vena cava (IVC) syndrome [1]. Although IVC syndrome is not as well-known as SVC syndrome, IVC obstruction can lead to superficial venous dilation as well as abdominal and lower limb edema [2]. It can have a diverse presentation, ranging from no symptoms to bilateral lower limb edema, hypotension, and supine hypotensive syndrome [2,3].Laparoscopic surgery is widely used to operate on various abdominal organs. Because carbon dioxide gas is insufflated intra-abdominally and the patient's position is changed in order to obtain the required field of view, the anesthesiologist needs to be vigilant regarding changes in the patient's vital signs during surgery.Although case reports of perioperative SVC syndrome are common, perioperative IVC syndrome has been rarely reported [4,5]. Here, we present a case of sustained hypotension due to compression of the IVC by intrathoracic herniation of peritoneal fat during laparoscopic anterior resection, along with a review of the literature. CASE REPORTA 65-year-old man (height, 161 cm; weight, 81 kg) was scheduled for a laparoscopic anterior resection after being diagnosed as having sigmoid colon cancer. The patient had no specific history except for hypertension. Preoperative Vena cava syndrome is caused by central venous obstruction and can be divided into superior vena cava syndrome and inferior vena cava (IVC) syndrome. Symptoms and signs of IVC syndrome vary from no symptoms to lower limb edema, hypotension, and typical venous stasis changes of the lower extremities, such as brownish discoloration of the skin, woody edema, and ulceration. Carbon dioxide pneumoperitoneum, lithotomyTrendelenburg position, and abdominal obesity could increase intra-abdominal pressure. We report a patient undergoing laparoscopic surgery who showed intrathoracic herniation of peritoneal fat induced by elevated intra-abdominal pressure due to the reasons mentioned above, resulting in IVC syndrome and hypotension perioperatively. The patient was treated with a conservative approach because he was asymptomatic except for hypotension on the first postoperative day.

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“…Endovascular therapy may reconstruct fluent lumen, remove the thrombus and quickly relieve the venous congestion. The ideal therapeutic regimen for malignant venous complications is endovascular therapy followed by radiotherapy, chemotherapy and anticoagulant therapy (9,10).…”

Section: Discussionmentioning

confidence: 99%

Endoluminal treatment for venous vascular complications of malignant tumors

Xiao

Tong

Shen

2012

Experimental and Therapeutic Medicine

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Abstract. The aim of this study was to explore the efficacy and safety of interventional treatment for venous vascular complications of malignant tumors. Sixty-one patients with venous vascular complications of malignant tumors were treated from May 2002 to May 2009; 37 men and 24 women with mean age 57.8 years (33-82 years). Lesions included acute deep vein thrombosis (n=18); venous stenosis or occlusion (n=32); tumor embolus in vein (n=11). The interventional therapeutic operations included vena cava filter implantation, transcatheter thrombolytic therapy, recanalization, percutaneous transluminal angioplasty (PTA) and stenting. The success rate of thrombolysis and stent implantation, the clinical success rate, complications, recurrence rate of the treated region and survival duration were recorded. Eighteen patients accepted filter and thrombolytic therapy with a success rate of 100%; total urokinase dosage was 7.42±1.49 (4.5-10) million units. Symptoms disappeared (n=15), were palliated (n=3) and thrombi were completely dissolved (n=2), almost completely dissolved (n=8, >90%), partially dissolved (n=6, 50-90%) and not dissolved (n=2, <50%). No pulmonary embolism emerged after the operation. Forty-three patients accepted recanalization, PTA and stent therapy with a success rate of 95.3% (41/43). Symptoms disappeared (n=25), were palliated (n=16) and did not change (n=2) 3 days following the operation. There were no severe complications during the procedure. During followup, 12 patients again suffered symptoms of venous occlusion and 47 patients died of tumor aggravation without symptom recurrence. As a result, interventional therapy has advantages including smaller injuries, well tolerance, high success rate, quick palliation of symptoms and superior clinical efficacy in the treatment of venous vascular complications for malignant tumors.

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Endovascular Stenting as the First Step in the Overall Management of Malignant Superior Vena Cava Syndrome

Cited by 106 publications

References 36 publications

Superior Vena Cava Syndrome in Thoracic Malignancies

Superior Vena Cava Syndrome in Thoracic Malignancies

Hypotension due to compression of the inferior vena cava by intrathoracic herniation of peritoneal fat during laparoscopic surgery - A case report -

Endoluminal treatment for venous vascular complications of malignant tumors

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