Long-Term Results of Endovascular Stent Placement in the Superior Caval Venous System

Smayra, Tarek; Otal, P.; Chabbert, V.; Chemla, Patricia; Romero, Miguel; Joffre, Francis; Rousseau, Hervé

doi:10.1007/s00270-001-0055-1

Cited by 123 publications

(74 citation statements)

References 16 publications

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“…The method has certain risks depending on the constellation of findings. As in reported cases of death after stent implantation due to right heart insufficiency, acute right heat failure developed in two patients in our cohort: Simultaneous symptomatic stenosis of the superior vena cava and the pulmonary artery due to tumor infiltration or compression apparently resulted in acute right hear failure due to the volume load on the right ventricle [20,30]. One of the two patients died on the same day as the intervention.…”

Section: Discussionsupporting

confidence: 63%

“…Surgical interventions with reconstruction of the superior vena cava are possible but can only be performed in few patients selected on the basis of strict criteria [17 -19]. In the last 20 years, it has been shown multiple times that endovascular stents for symptomatic therapy of superior vena cava syndrome have great potential regarding symptom control and prevention of relapse [7,20,28].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of the dyspnea and edema of the face, neck and upper extremities also facilitates subsequent or current treatment of the underlying tumor disease. This improves the patient's overall clinical condition [7,20].…”

Section: Materials Und Methodsenmentioning

confidence: 99%

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Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause

Büstgens

Loose

Ficker

et al. 2017

Fortschr Röntgenstr

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Purpose?The purpose of this paper is the retrospective analysis of endovascular therapy for the treatment of superior vena cava syndrome (SVCS) of malignant cause. This study focuses on the effectiveness of the therapy regarding the duration of remission, symptom control and practicability. Materials and Methods?From January 2003 to November 2012, therapeutic implantation of one or more stents was performed in 141 patients suffering from SVCS.?The medical history was retrospectively researched using digitalized patient files. If those were incomplete, secondary research was conducted using the cancer registry of the General Hospital Nuremberg, the cancer registry of the tumor center at Friedrich-Alexander-University Erlangen-Nuremberg (FAU) or information given by physicians in private practice. This data was collected using Microsoft Office Excel? and statistically analyzed using IBM SPSS Statistics 22?. Results?168 stents were implanted in 141 patients (median age: 64.6?years; range: 36???84), 86 being male and 55 being female. In 121 patients, SVCS was caused by lung cancer (85.8?%), in 9 patients by mediastinal metastasis of an extrathoracic carcinoma (6.4?%), in 3?patients by mesothelioma of the pleura (2.1?%) and in 1 patient by Hodgkin?s disease (0.7?%). There was no histological diagnosis in 7?cases (4.9?%). The primary intervention was successful in 138 patients (97.9?%). Immediate thrombosis in the stent occurred in the remaining 3 cases. Recurrence of SVCS was observed in 22 patients (15.6?%), including 5 early and 17 late occlusions. Stent dislocation or?breakage was not observed. As expected, the survival after implantation was poor. The median survival was 101 days, and the median occlusion-free survival was 80 days. Conclusion?The symptomatic therapy of SVCS with endovascular stents is effective and safe. Despite effective symptom control and a low rate of recurrence, the patients' prognosis is poor. Key Points:? Citation Format

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

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Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause

Büstgens

Loose

Ficker

et al. 2017

Fortschr Röntgenstr

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“…Excess dilatation may induce adjacent lumen compression or collapse for example presenting as dyspnea due to tracheal collapse. There are various complications (24)(25)(26)(27) related to vena cava stent implantation, including pulmonary edema resulting from a high venous return, stent migration, pulmonary embolus, cardiac tamponade and local pain. To avoid stent migration, the diameter of the stent should be greater than that of the normal vein, and the length of the stent should be 2-4 cm longer than that of the lesion.…”

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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“…6 A total of 16 cases of SVC perforation and hemopericardium have been described in the literature. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The majority of ruptures became clinically apparent near the time of stenting-seven intraprocedurally, six within 1 hour of the procedure, and one more within 24 hours. However, fatal ruptures caused by strut erosion into the pericardium have been reported at 3 and 6 months postprocedure.…”

Section: Svc Rupture and Cardiac Tamponade As A Complication Of Stentingmentioning

confidence: 99%

Superior Vena Cava Rupture and Cardiac Tamponade Complicating the Endovascular Treatment of Malignant Superior Vena Cava Syndrome: A Case Report and Literature Review

Stevens

Butty

Johnson

2015

Semin intervent Radiol

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A 47-year-old man with known metastatic small cell lung cancer presented with 1 week of right arm swelling, facial flushing, shortness of breath, right hand weakness, and intermittent blurry vision. Physical examination revealed right upper extremity edema and facial plethora. Computed tomography (CT) of the chest confirmed enlargement of a right upper lobe mass causing near-complete occlusion of the right brachiocephalic vein and superior vena cava (SVC) (►Fig. 1), consistent with SVC syndrome (SVCS). After extensive discussion regarding the risks and benefits of the procedure, the patient elected to proceed with endovascular reconstruction of the central veins.Bilateral basilic vein access was obtained, and digital upper extremity venography confirmed near-complete occlusion of the SVC (►Fig. 2). The occlusion was traversed using a 0.035-inch wire and a 5F catheter, and intraluminal crossing was confirmed with contrast injection. Throughand-through access was obtained via the right common femoral vein, and the SVC and brachiocephalic veins were dilated using 8-and 10-mm balloons (►Fig. 3). Venogram immediately following the 10-mm angioplasty demonstrated contrast extravasation into the mediastinum and likely the pericardial space, indicative of SVC rupture (►Fig. 4). Ultrasound revealed a thin pericardial effusion, which, given the patient's history of radiation, was deemed sufficient to cause tamponade. Overlapping 13 mm Â 5 cm Viabahn-covered stents (Gore Medical, Flagstaff, AZ) were placed from the central aspect of the left brachiocephalic vein to the atriocaval junction (►Fig. 5). However, the patient rapidly decompensated, and despite aggressive resuscitation following advanced cardiac life support (ACLS) protocol, including pericardiocentesis, the patient expired on the table.

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Long-Term Results of Endovascular Stent Placement in the Superior Caval Venous System

Abstract: Primary stenting of superior caval obstruction is a first-choice treatment method achieving good mid-term patency. Patients with hemodialysis shunts must be closely monitored for early reintervention.

Cited by 123 publications

References 16 publications

Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause

Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause

Endoluminal treatment for venous vascular complications of malignant tumors

Superior Vena Cava Rupture and Cardiac Tamponade Complicating the Endovascular Treatment of Malignant Superior Vena Cava Syndrome: A Case Report and Literature Review

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