Use of self-expanding vascular endoprostheses in superior vena cava syndrome

• Published in: European journal of cardio-thoracic surgery 2003-08, Vol.24 (2), p.208-211
• Main Authors: García Mónaco, R., Bertoni, H., Pallota, G., Lastiri, R., Varela, M., Beveraggi, E.M., Vassallo, B.C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood Vessel Prosthesis Implantation - mortality; Catheterization - adverse effects; Chondrosarcoma - complications; Chondrosarcoma - surgery; Diseases of the cardiovascular system; Female; Humans; Lung Neoplasms - complications; Lung Neoplasms - surgery; Lymphoma, Non-Hodgkin - complications; Lymphoma, Non-Hodgkin - surgery; Male; Mediastinal syndrome; Medical sciences; Melanoma - complications; Melanoma - surgery; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Reoperation; Stents; Superior vena cava syndrome; Superior Vena Cava Syndrome - etiology; Superior Vena Cava Syndrome - mortality; Superior Vena Cava Syndrome - surgery; Survival Rate; Thrombosis - complications; Thrombosis - surgery; Treatment Outcome; Vascular endoprotheses; Vascular stenting
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(03)00293-8

Introduction: Superior vena cava syndrome (SVCS) is associated to a malignant tumor in more than 90% of cases; being the lung cancer the most frequent (80%). SVCS has a benign cause in less than 5% of cases. Endovascular stenting has been proposed as the primary treatment of choice. We report our experience in SVC recanalization through the use of self-expanding vascular stents as treatment of life-threatening SVCS of benign and malignant etiology. Materials and methods: Between January 1994 and April 2002 44 patients with critical SVCS, were treated at the Hospital Italiano de Buenos Aires. Forty nine self-expanding endovascular metallic stents were percutaneously placed in the SVC. Thirty-one (70%) patients were male and 13 (30%) were female. The mean age was 55.6 years (range: 21–77). The etiology of SVCS was malignant in 40 cases and benign in 4. The malignant causes included lung cancer: 37 (37/44–92.5%), lymphoma: 1 (2.5%), chondrosarcoma 1 (2.5%), melanoma 1 (2.5%). The benign etiology corresponded to central catheters (n: 2) and post-radiation fibrosis (n: 2). Cavography showed complete occlusion of SVC in 12 cases (27%) and significant partial stenosis in 32 cases (73%). Thrombi associated with tumor stenosis were present in 25 (57%) patients. Results: All procedures were technically successful. No stent migration was observed. Thirty-two patients with malignant tumor ultimately died due to the progression of the disease. Mean survival time was 193 days (range: 25–578). SVCS recurrence was observed on six occasions. In four patients a new stent was placed. Symptomatic improvement was dramatically seen within 24–48 h after stent placement in 40 patients (90.9%) and 83.3% out of the cases (38/44) were symptoms-free during the rest of the disease. Three patients died in the 7 following days. Conclusion: The use of self-expanding vascular endoprostheses in the recanalization treatment of SVC in SVCS due to a malignant or benign etiology offers excellent results with rapid and prolonged remission of symptoms.