Stenting in malignant and benign vena caval obstruction

Abstract

Expandable metallic stents have been used with considerable success for the palliation of malignant vena caval obstruction. The role of stenting in vena caval obstruction of benign aetiology is less well defined. A review of 11 patients stented for vena caval obstruction and a review of recent series in the literature is presented. Of the 11 patients, seven patients had involvement of the superior vena cava (SVC), and four patients had inferior vena caval (IVC) obstruction. Seven cases had malignant vena caval obstruction, with a benign aetiology (SVC n = 3; IVC n = 1) in the other four cases. All seven patients treated with SVC stents experienced complete resolution or significant improvement in symptoms with no recurrence over the duration of available follow-up, over an average of 4.3 months (range: 1 week-12 months). Only one of four IVC lesions stented resulted in a good clinical response. All four patients with vena caval obstruction of benign aetiology had a good outcome. One patient experienced a small pulmonary embolus following SVC stent insertion without further sequelae. No other serious complications were encountered. Stenting can provide prompt relief of vena caval obstruction with low morbidity, and high patency rates in both benign and malignant vena caval lesions.

Successful stenting of a complex inferior vena cava stenosis using a modified sharp recanulization technique

“…Percutaneous management is a preferred modality in view of its wider acceptability, simplicity, procedure ease, lesser morbidity, and acceptable acute as well as midterm outcome [10,11]. Balloon angioplasty and stent implantation in IVC stenosis has been evaluated extensively in different studies [1][2][3][4][5][6][7][8][9][10][11][12]. Acute and midterm results of both balloon-expandable and self-expandable stents are satisfactory [3,4,8,10,11].…”

“…Roles of surgical and percutaneous procedures as well as local thrombolysis are also clearly demonstrated [1][2][3][4][5][6][7][8][9][10][11][12]. Percutaneous management is a preferred modality in view of its wider acceptability, simplicity, procedure ease, lesser morbidity, and acceptable acute as well as midterm outcome [10,11].…”

“…Balloon angioplasty of inferior vena cava (IVC) stenosis is a well-accepted interventional procedure [1][2][3][4][5][6][7][8][9][10][11][12]. Role of stenting is also established [2][3][4][5][6][7][8][9][10][11][12].…”

“…Role of stenting is also established [2][3][4][5][6][7][8][9][10][11][12]. These interventions have been used successfully in different subsets of IVC stenosis, including Budd-Chiari Syndrome, postliver transplantation IVC stenosis, and venous stenosis in tumor patients [1][2][3][4][5][6][7][8][9][10][11][12]. We describe a case of long-segment, thrombotic, chronic total occlusion (CTO) that was dilated and stented using a modified sharp recanulization technique involving the use of Brokenborough septal puncture (SP) needle and Mullin dilator.…”

Use of endovascular metal stents to alleviate malignant superior vena cava syndrome

“…Symptoms can recur in approximately 20% of cases and may be due to: (i) tumour growth, (ii) tumour ingrowth through the stent struts, (iii) radiation fibrosis or (iv) superimposing thrombosis. Complications can arise, including: (i) stent migration, (ii) compression of the phrenic nerve against the tumour mass and (iii) puncture site haematoma 6 …”