Gianturco-Rösch expandable Z-stents in the treatment of superior vena cava syndrome

Abstract

Gianturco-Rösch expandable Z-stents were used in 22 patients with superior vena cava syndrome (SVCS). Stents were placed in all patients in the SVC and in 17 patients, also into the innominate veins. Stent placement resulted in complete relief of symptoms in all patients. Twenty-one patients had no SVCS recurrence from 1 to 16 months, to their death, or to the present time. SVCS recurred only in 1 patient 9 months after stent placement due to tumor ingrowth and secondary thrombosis. Based on ours and on other reported experiences, expandable metallic stents are effective devices for treatment of the SVCS which is difficult to manage by other means.

Vascular Stenting for Palliation of Superior Vena cava Obstruction in Non-Small-Cell Lung Cancer Patients: A Future ‘Standard’ Procedure?

“…At last, stenting was performed without immediate or late complication in the present study. However, migration or misplacement of the stent [15], thoracic pain during balloon inflation [6, 21, 26], acute cardiogenic pulmonary edema [16, 28], cardiac tamponade [2], venous tear [11]or transient hemidiaphragm elevation [14]have been reported in the literature. In addition, the anticoagulation therapy may cause complications since 1 episode of hemoptysis occurred.…”

“…Palliative treatment of SVCO uses radiotherapy and/or chemotherapy leading to a 59.8% overall response rate [22], while vascular stenting allows relief of symptoms in 85 to 100% of cases [6, 8, 10, 11, 14, 21, 26, 27]. Comparison with previously reported results is quite difficult because of patient’s heterogeneity (especially the presence of nonmalignant SVCO [24]or a large number of SCLC patients [15]better responding to radiotherapy or chemotherapy) and the lack of a worldwide accepted scale for scoring SVCO.…”

“…The first stent was implanted by Charnsangavej et al [4]in 1986 with encouraging results in 1 patient with SVCO. Since the early 90s, stent placement was used especially after failure of the first-choice treatment (radiotherapy and/or chemotherapy) [6, 8, 10, 11, 14, 21, 26, 27]. In few cases, the time of vascular stenting is not clearly known [16, 23].…”

Tratamento da síndrome da veia cava superior

“…In a study of thirteen patients submitted to stent placement and monitored for three days to six months, no recurrence was observed. (36) In another study, involving eleven patients monitored for one to eleven months, only one case of recurrence was observed. (37) The authors of yet another study achieved clinical success in 93% of the patients treated, with no recurrences during a one-to fourteen-month follow-up period.…”

“…(38) The rates of recurrence reported in the literature range from 0% to 45%. (36) The recurrence of the obstruction of the superior vena cava, secondary to the growth of the tumor in the interstices or along the stent borders and resulting in thrombosis, can be related to various factors. In three different studies involving a total of 56 patients, one case of recurrence of SVCS secondary to the growth of the tumor was reported.…”