Superior vena caval obstruction managed by the gianturco Z stent

Gaines, Peter A.; Belli, Anna‐Maria; Anderson, Paul B.; McBride, Katharine; Hemingway, A. P.

doi:10.1016/s0009-9260(05)81778-7

Cited by 58 publications

(28 citation statements)

References 9 publications

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“…Interestingly, however, quantification on the alteration of hemodynamic flow parameters related to neointimal hyperplasia and restenosis associated with the Gianturco Z-stent configuration is limited in the literature. Past work has focused on their elastic and mechanical behavior [14,15], renal artery patency and renal function in arteries covered by Gianturco Z-stents [16], efficacy in malignant esophagorespiratory fistulas [17], management of superior vena cava obstruction [18], and treatment of a subclavian artery aneurysm [19]. Guivier-Curien et al [20] used CFD to model fluid dynamics and drag forces involved with custom made stent grafts composed of 25 mm long Gianturco Z-stents covered in polyester.…”

Section: Introductionmentioning

confidence: 99%

The Quantification of Hemodynamic Parameters Downstream of a Gianturco Zenith Stent Wire Using Newtonian and Non-Newtonian Analog Fluids in a Pulsatile Flow Environment

Walker

Johnston

Rival

2012

Journal of Biomechanical Engineering

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Although deployed in the vasculature to expand vessel diameter and improve blood flow, protruding stent struts can create complex flow environments associated with flow separation and oscillating shear gradients. Given the association between magnitude and direction of wall shear stress (WSS) and endothelial phenotype expression, accurate representation of stent-induced flow patterns is critical if we are to predict sites susceptible to intimal hyperplasia. Despite the number of stents approved for clinical use, quantification on the alteration of hemodynamic flow parameters associated with the Gianturco Z-stent is limited in the literature. In using experimental and computational models to quantify strut-induced flow, the majority of past work has assumed blood or representative analogs to behave as Newtonian fluids. However, recent studies have challenged the validity of this assumption. We present here the experimental quantification of flow through a Gianturco Z-stent wire in representative Newtonian and non-Newtonian blood analog environments using particle image velocimetry (PIV). Fluid analogs were circulated through a closed flow loop at physiologically appropriate flow rates whereupon PIV snapshots were acquired downstream of the wire housed in an acrylic tube with a diameter characteristic of the carotid artery. Hemodynamic parameters including WSS, oscillatory shear index (OSI), and Reynolds shear stresses (RSS) were measured. Our findings show that the introduction of the stent wire altered downstream hemodynamic parameters through a reduction in WSS and increases in OSI and RSS from nonstented flow. The Newtonian analog solution of glycerol and water underestimated WSS while increasing the spatial coverage of flow reversal and oscillatory shear compared to a non-Newtonian fluid of glycerol, water, and xanthan gum. Peak RSS were increased with the Newtonian fluid, although peak values were similar upon a doubling of flow rate. The introduction of the stent wire promoted the development of flow patterns that are susceptible to intimal hyperplasia using both Newtonian and non-Newtonian analogs, although the magnitude of sites affected downstream was appreciably related to the rheological behavior of the analog. While the assumption of linear viscous behavior is often appropriate in quantifying flow in the largest arteries of the vasculature, the results presented here suggest this assumption overestimates sites susceptible to hyperplasia and restenosis in flow characterized by low and oscillatory shear.

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Section: Introductionmentioning

confidence: 99%

The Quantification of Hemodynamic Parameters Downstream of a Gianturco Zenith Stent Wire Using Newtonian and Non-Newtonian Analog Fluids in a Pulsatile Flow Environment

Walker

Johnston

Rival

2012

Journal of Biomechanical Engineering

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“…(27)(28)(29)(30)(31)(32) Regardless of the type of stent used, immediate relief of symptoms such as headache has been reported by various authors. Cyanosis and facial edema improve in one or two days, (31)(32)(33)(34) and edema of the upper limbs is generally resolved two or three days after the insertion of the stent (23,30,34) but can persist for up to one week.…”

Section: Clinical Resultsmentioning

confidence: 99%

“…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. (28)(29)37) The authors of all three studies employed Gianturco stents, suggesting that the open architecture of the stent leaves it more susceptible to proliferation of the tumor. Such tumor infiltration has not been reported with use of the Wallstent or Palmaz stents, although tumor growth can occur along the borders of all types of stents, resulting in recurrence of the symptoms.…”

Section: Clinical Resultsmentioning

confidence: 99%

“…In two different studies, thrombosis occurred (one case in each study) soon after the placement of the stent in the superior vena cava in patients who had not been submitted to anticoagulation. (29,31) The recurrence of SVCS can be treated using interventional radiological techniques. Thrombolysis, angioplasty, and the placement of an additional stent have been reportedly used as successful treatment modalities in cases of recurrence.…”

Section: Clinical Resultsmentioning

confidence: 99%

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Tratamento da síndrome da veia cava superior

et al. 2005

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The superior vena cava is formed by the union of the right and left brachiocephalic veins. It is located in the middle mediastinum, to the right of the aorta and anterior to the trachea. Superior vena cava syndrome consists of a group of signs (dilation of the veins in the neck, facial swelling, edema of the upper limbs, and cyanosis) and symptoms (headache, dyspnea, cough, orthopnea and dysphagia) caused by the obstruction of blood flow through the superior vena cava to the right atrium. This obstruction can be caused by extrinsic compression, tumor invasion or thrombosis. Such obstruction may also occur as a result of insufficient venous return secondary to intra-atrial or intraluminal diseases. From 73% to 93% of all cases of superior vena cava syndrome occur during the development of an intrathoracic tumor. Most patients presenting superior vena cava syndrome secondary to malignant neoplasms are treated without surgery, through radiotherapy, chemotherapy or the use of intraluminal stents. When the etiology of superior vena cava syndrome is benign, it can be treated with clinical measures (anticoagulation, raising the head, etc.) or, in refractory cases, with angioplasty, stents or surgery.

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“…And R6sch et al advocate lifelong anticoagulation after stenting in all patients with malignant SVCS [7]. Heparin was given at therapeutic dosage for 1-5 days after the procedure in most of the published series [7,8,22,23,45,[51][52][53]. Anti-platelet therapy was performed by Kishi et al using 1000mg ASS (iv) for 7 days and 3000mg (po) for another 7 days [5]; Dyet et al used 300mg ASS for 3 months [23], and Watkinson gave 75mg until patients death [8].…”

Section: Figurementioning

confidence: 99%

Superior Vena Cava Syndrome. From the Bronchus to the Vessel

Witt

Schmidt

Borges

et al. 1997

Diagnostic and Therapeutic Endoscopy

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This paper addresses the diagnosis and management of superior vena cava syndrome (SVCS) due to malignant intrathoracic tumours. Diagnosis of SVCS is usually established by bedside examination. Chest X-ray and computed tomography may be helpful, but the cavography remains the "gold-standard .O ther imaging techniques (MRI, nuclear flow studies) are more of scientific interest. Bronchoscopy helps to evaluate the risk of pulmonary complications and endoscopic procedures often lead to histological findings. In the treatment of malignant SVCS surgery, radiotherapy, and chemotherapy have been successfully used. The placement of a vascular stent might be an additional or alternative possibility. There are no conclusive indication criteria and no conclusive regimen concerning post-stenting anticoagulation. From all reported results and published papers we draw the conclusion that the immediate effects of stent implantation and the long-term results of tumour-specific therapy are complementary to one another. The stent dilates the local venous stenosis while tumour-specific therapy has a general effect on the vascular and respiratory situation in a multi-therapy concept.

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Superior vena caval obstruction managed by the gianturco Z stent

Cited by 58 publications

References 9 publications

The Quantification of Hemodynamic Parameters Downstream of a Gianturco Zenith Stent Wire Using Newtonian and Non-Newtonian Analog Fluids in a Pulsatile Flow Environment

The Quantification of Hemodynamic Parameters Downstream of a Gianturco Zenith Stent Wire Using Newtonian and Non-Newtonian Analog Fluids in a Pulsatile Flow Environment

Tratamento da síndrome da veia cava superior

Superior Vena Cava Syndrome. From the Bronchus to the Vessel

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