Endovascular treatment of superior vena cava obstruction in patients with malignancies

Abstract

The aim of this study was to report our experience on the management of superior vena cava obstruction (SVCO) secondary to malignant disease, using endovascular procedures. Twenty-six patients with SVCO due to primary or secondary tumors of the lung or the mediastinum, or catheter inserted for treatment of an extra-thoracic neoplasm, had an endovascular therapy which consisted of stenting, angioplasty, thrombo-aspiration or local fibrinolysis. Immediately after the procedure, rapid relief of symptoms occurred in 24 (90 %) of the patients. The mean Kishi's score decreased from 5.5 to 0.96. Immediate complications included one death related to pericarditis bleeding following fibrinolysis. Three patients relapsed after 20 days, 4 months and 6 months, and needed a second stenting. At 6 months the primary patency rate was 83 % and the secondary patency rate was 89 %. Endovascular treatment of SVCOs is a simple and safe procedure to restore the patency of the superior vena cava in malignant SVCO. It should be indicated in most cases as first-line treatment and performed as early as possible.

Percutaneous treatment of superior vena cava syndrome using metallic stents

“…This property allows the stent to oppose the forces exerted by the extrinsic tumour, the elasticity of the vessel wall and formation of scar tissue. Stents provide a significant palliation of the symptoms in the majority of patients in almost all of the series published (Table 2) [17,34,35,52]. After stent implantation, 70-100% of patients report remission of symptoms.…”

“…The patient was infused with intravenous heparin to maintain the activated partial thromboplastin time 1.5 times above normal. Mechanical thrombolysis is an effective endovascular procedure with specific indications [52,53,54,55]. The thrombolysis can be considered complete when 95% of the thrombus has disappeared.…”

Double-flash, large-fraction radiation therapy as palliative treatment of malignant superior vena cava syndrome in the elderly

“…According to this point of view, SVCS should not be always considered a life-threatening condition unless severe respiratory impairment and/or tracheal obstruction are present simultaneously [18]. Although endovascular procedures (stenting, angioplasty, local fibrinolysis) have been used with significant success, since response is usually immediate [23,26,32], most patients suffering from neoplastic SVCS undergo noninvasive management. In fact, since the goals of the treatment should be not only to relieve symptoms, but also to cure the primary neoplasm involved, multimodality approaches may be used in selected patients [28].…”

Central venous access: techniques and indications in oncology

“…This is nevertheless mandatory in patients with persistent ipsilateral upper limb oedema and/or presenting with venous tumour compression/invasion. SVC syndrome can be successfully treated by means of interventional radiological procedures [47]. Usually, the catheter should be placed through a fully expanded SVC stent.…”