Endovascular Stenting in Superior Vena Cava Syndrome: A Systematic Review and Meta-analysis

Abstract

Purpose Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). Methods MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper–Pearson estimation. Results Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0–97.5%) and 92.8% (95% CI 91.7–93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0–93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). Conclusions This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. Level of Evidence Level III, systematic review of retrospective cohort studies.

Should endovascular stenting be used routinely as first-line treatment for malignant superior vena cava syndrome?—a critical review in the context of recent advances in oncological treatments

“…While there are no differences in the technical success rates observed in the brands of stents, retrospective studies demonstrated that covered stents provide better long-term patency compared to non-covered stents (16)(17)(18). Some interventionalists routinely give a bolus of heparin during the procedure, but it is not a universal practice, as doing so can increase the risks of bleeding (14,19,20). When extensive thrombus is encountered, thrombolysis or occasionally thrombectomy may first be performed to reduce the length of the stenosis before stent insertion (13,14).…”

“…Anticoagulation after stenting remains a controversial issue. While some advocate routine administration of anticoagulation to prevent in-stent thrombosis, some only prescribe anticoagulation when SVC thrombosis is present (14,19,20). The type of anticoagulation also varies amongst interventionists.…”

“…The type of anticoagulation also varies amongst interventionists. Options include warfarin, heparin, aspirin, clopidogrel or their combinations (19,20). When anticoagulation is prescribed, the duration is not standardized as well, with clinicians prescribing it from three months to lifelong (20).…”

“…Three systematic reviews and one literature review on endovascular stenting confirmed the high clinical success rates of stenting in Rowell and Gleeson's study. The literature review of Léon et al focused specifically on patients with malignant SVCS (30), whereas the systematic reviews included SVCS patients with both benign and malignant causes (19,20,31). The average clinical success rates were above 90% for all studies (19,20,30,31).…”

“…The literature review of Léon et al focused specifically on patients with malignant SVCS (30), whereas the systematic reviews included SVCS patients with both benign and malignant causes (19,20,31). The average clinical success rates were above 90% for all studies (19,20,30,31). Symptom recurrence rates after stenting were around only 10% (19,20).…”