Endovascular Treatment of Malignant Superior Vena Cava Syndrome through Upper-Limb Access: A Comparison between Venous-Dedicated and Conventional Stents

Abstract

Purpose: To retrospectively evaluate the technical and clinical outcomes of superior vena cava (SVC) stent placement through upperlimb venous access in malignant SVC syndrome (SVCS) and compare the efficacy of different nitinol stent types. Materials and Methods: Between 2006 and 2018, 156 patients (132 male; mean age, 62 y; age range, 33-81 y) underwent SVC stent placement for malignant obstructions through upper-limb venous access with 1 of 3 types of nitinol stent: 1 venous-dedicated (Sinus-XL stent) and 2 non-venous-dedicated (E-Luminexx Vascular Stent and Prot eg e GPS). Cases of common femoral vein access or non-nitinol stents were excluded from further analysis. The mean duration of follow-up was 8 mo. Results: Technical success was achieved in 99.3% of cases. One patient died during the procedure as a result of cardiac tamponade. Balloon predilation was performed in 10 patients and postdilation in 126. Mean procedural time was 34.4 min (range, 18-80 min). Overall survival rates were 92.3%, 57.3%, and 26.8%, and overall primary patency rates were 94.5%, 84.8% and 79.6%, at 1, 6, and 12 mo, respectively. There were no statistically significant differences in primary patency rates between venous-and non-venous-dedicated stents or among different Stanford SVCS grading groups (P > .05). Conclusions: SVC stent placement through an upper-limb approach is a safe, fast, and effective technique. There is no evident benefit of venous-dedicated vs non-venous-dedicated stents in the treatment of malignant SVCS.

Safety and Effectiveness of Abre Self-Expanding Venous Stent for Treatment of Superior Vena Cava Syndrome

“…A study by Matthaiou et al demonstrated no significant difference in primary patency rates for venous and non-venous-dedicated stents in the setting of malignant SVC syndrome in 156 patients. 16 However, there is currently limited clinical outcome data supporting the specific use of the Abre TM stent for SVC syndrome. Few studies have reported clinical improvement in the management of central venous occlusion in hemodialysis patients using the Abre TM stent, 9 while studies reporting use of the Abre TM for SVC syndrome have limited clinical follow-up.…”