201
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Affiliation(s)
- T Kuga
- First Department of Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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202
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Fusetti C, Renggli JC, Wellensiek B, Becciolini C, Merlini M. [Chronic saphenous venous access: an interesting alternative in the case of vena cava superior syndrome]. Chirurg 1999; 70:1036-40. [PMID: 10501670 DOI: 10.1007/s001040050763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
An easy venous access improves the quality of life of patients who need prolonged intravenous therapy. In the case of vena cava superior syndrome the classic access in the jugular or subclavian vein can be difficult or even impossible. We report on seven implantations of Port-a-Cath in the inferior vena cava for patients presenting contra-indications to classic venous access to the vena cava superior (five cases of vena cava superior compression syndrome, one tracheostomy and one extended tumor of thoracic wall). We describe the operative technique and we analyze the indications, the results and the complications of this rarely used technique.
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Affiliation(s)
- C Fusetti
- Service de Chirurgie, Hôpital de la Ville, La Chaux-de-Fonds
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203
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Abstract
Malignant superior vena caval (SVC) syndrome due to non-small cell lung cancer is invariably fatal, with most therapy directed toward palliating the manifestations of the disease. A cure, by means of any modality, is unusual. We report a patient with SVC syndrome secondary to documented ipsilateral peritracheal nodal involvement (stage IIIB disease) who underwent neoadjuvant chemoradiotherapy and resection. At surgery, his superior vena cava was not involved and his tumor had been downstaged to stage I (T1 nanoseconds). He remains alive and free of disease 60 months after surgery. Neoadjuvant chemoradiotherapy may be used to downstage malignant SVC syndrome to resectable lesions in good functional candidates.
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Affiliation(s)
- J R Roberts
- Department of Cardiac and Thoracic Surgery, Vanderbilt University Hospital, Nashville, TN 37027, USA.
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204
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Young N, Glare P. Use of a metallic stent for relief of symptoms caused by superior vena caval obstruction in a patient with advanced cancer: a case report. J Pain Symptom Manage 1999; 18:56-60. [PMID: 10439574 DOI: 10.1016/s0885-3924(99)00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This report describes the insertion of a metallic stent in the superior vena cava to relieve the symptoms of malignant superior vena caval obstruction in a 75-year-old woman with far-advanced lung cancer in whom other methods of symptom control had been ineffective. Her symptoms were quickly relieved by insertion of the stent. She died 1 month following the procedure, without recurrence of the symptoms. The technical aspects of the procedure and the issues affecting the clinical decision-making process in this case are discussed.
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Affiliation(s)
- N Young
- Department of Radiology, Westmead Hospital, New South Wales, Australia
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205
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Qanadli SD, El Hajjam M, Mignon F, de Kerviler E, Rocha P, Barré O, Chagnon S, Lacombe P. Subacute and chronic benign superior vena cava obstructions: endovascular treatment with self-expanding metallic stents. AJR Am J Roentgenol 1999; 173:159-64. [PMID: 10397119 DOI: 10.2214/ajr.173.1.10397119] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our purpose is to report our clinical experience with patients who underwent endovascular treatment with Wallstents for subacute or chronic benign obstruction of the superior vena cava (SVC). SUBJECTS AND METHODS Twelve patients who were an average of 54 +/- 12 years old were referred for treatment of severe SVC syndrome related to implanted central venous catheters (n = 8), postradiation fibrosis (n = 2), a permanent pacemaker (n = 1), or a benign tumor (n = 1). Symptoms were present for an average of 16 weeks (range, 4-48 weeks) before treatment. Diagnosis of SVC obstruction was confirmed with helical CT and pretherapeutic phlebography. Four patients had Stanford's type II stenosis; two, type III; and six, type IV. The mean clinical and radiologic follow-up intervals were 11 months (range, 1-36 months) and 7 months (range, 1 week to 32 months), respectively. RESULTS Recanalization was successful in all patients. Fifteen stents were implanted in the 12 patients. Stents were placed after percutaneous balloon angioplasty in nine patients, and primary stent placement was attempted in three patients. We immediately achieved a satisfactory SVC diameter in all patients, whose symptoms were relieved completely within 1 week of stent placement. No technical or clinical complications occurred. SVC syndrome recurred in one patient 2 months after stent placement and was treated by placing a second stent. CONCLUSION Endovascular treatment with stent placement should be considered relevant and safe for refractory benign SVC syndrome. However, a larger series and a longer follow-up period are needed to define the role of stent placement for this syndrome.
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Affiliation(s)
- S D Qanadli
- Department of Radiology, Ambroise Paré Hospital, University René Descartes-Paris V, Boulogne, France
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206
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Perno J, Putnam SG, Cohen GS, Ball D. Endovascular treatment of superior vena cava syndrome without removing a central venous catheter. J Vasc Interv Radiol 1999; 10:917-8. [PMID: 10435710 DOI: 10.1016/s1051-0443(99)70137-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- J Perno
- Department of Diagnostic Imaging, Temple University Hospital, Philadelphia, PA 19140, USA
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207
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Thony F, Moro D, Witmeyer P, Angiolini S, Brambilla C, Coulomb M, Ferretti G. Endovascular treatment of superior vena cava obstruction in patients with malignancies. Eur Radiol 1999; 9:965-71. [PMID: 10370001 DOI: 10.1007/s003300050777] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to report our experience on the management of superior vena cava obstruction (SVCO) secondary to malignant disease, using endovascular procedures. Twenty-six patients with SVCO due to primary or secondary tumors of the lung or the mediastinum, or catheter inserted for treatment of an extra-thoracic neoplasm, had an endovascular therapy which consisted of stenting, angioplasty, thrombo-aspiration or local fibrinolysis. Immediately after the procedure, rapid relief of symptoms occurred in 24 (90 %) of the patients. The mean Kishi's score decreased from 5.5 to 0.96. Immediate complications included one death related to pericarditis bleeding following fibrinolysis. Three patients relapsed after 20 days, 4 months and 6 months, and needed a second stenting. At 6 months the primary patency rate was 83 % and the secondary patency rate was 89 %. Endovascular treatment of SVCOs is a simple and safe procedure to restore the patency of the superior vena cava in malignant SVCO. It should be indicated in most cases as first-line treatment and performed as early as possible.
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Affiliation(s)
- F Thony
- Department of Radiology and Medical Imaging, CHU A Michallon, BP 217, F-38043 Grenoble Cedex 09, France
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208
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Mae M, Oyama K, Tatebayashi T, Sakuraba M, Kanzaki M, Yoshida T, Ohnuki T, Nitta S. [The use of the Wallstent prosthesis in the treatment of superior vena cava syndrome]. Kyobu Geka 1999; 52:395-7. [PMID: 10319629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Five patients (4 men and one woman) aged 48-82 years who were suffering from superior vena cava (SVC) syndrome had Wallstent implanted percutaneously to relieve the obstruction. After stent placement, all cases received anticoagulant therapy with heparin. However one transient stent thrombosis occurred, stent placement resulted in complete relief of all patients. Wallstent placement could be an extremely useful treatment for SVC syndrome and should be the treatment of choice in all cases where SVC obstruction occurs or recurs, following chemotherapy or radiotherapy.
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Affiliation(s)
- M Mae
- Department of Surgery I, Tokyo Women's Medical University, Japan
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209
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Owens CA, Warner D, Yaghmai B, Dickstein R, Benedetti E, Wiley T. Re: Creating a TIPS in a patient with difficult venous access: use of a nonfunctioning Denver shunt to access an occluded superior vena cava. Cardiovasc Intervent Radiol 1999; 22:262-3. [PMID: 10382064 DOI: 10.1007/s002709900381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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210
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Stockx L, Raat H, Donck J, Wilms G, Marchal G. Repositioning and leaving in situ the central venous catheter during percutaneous treatment of associated superior vena cava syndrome: a report of eight cases. Cardiovasc Intervent Radiol 1999; 22:224-6. [PMID: 10382054 DOI: 10.1007/s002709900371] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe a combined procedure of repositioning and leaving in situ a central venous catheter followed by immediate percutaneous treatment of associated superior vena cava syndrome (SVCS). METHODS Eight patients are presented who have central venous catheter-associated SVCS (n = 6 Hickman catheters, n = 2 Port-a-cath) caused by central vein stenosis (n = 4) or concomitant thrombosis (n = 4). With the use of a vascular snare introduced via the transcubital or transjugular approach, the tip of the central venous catheter could be engaged, and repositioned after deployment of a stent in the innominate or superior vena cava. RESULTS In all patients it was technically feasible to reposition the central venous catheter and treat the SVCS at the same time. In one patient flipping of the Hickman catheter in its original position provoked dislocation of the released Palmaz stent, which could be positioned in the right common iliac vein. CONCLUSION Repositioning of a central venous catheter just before and after stent deployment in SVCS is technically feasible and a better alternative than preprocedural removal of the vascular access.
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Affiliation(s)
- L Stockx
- Department of Radiology, Catholic University of Leuven, University Hospitals, Belgium
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211
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Abstract
Superior vena cava (SVC) syndrome is a relatively common complication of lung cancer or lymphoma, and in fact is often the initial manifestation of these diseases. However, benign causes also exist, and physicians should not automatically assume that SVC syndrome is due to cancer. A definitive histologic diagnosis of cancer should be obtained before starting radiotherapy or chemotherapy to treat SVC syndrome.
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Affiliation(s)
- M Markman
- Department of Hematology/Medical Oncology, Cleveland Clinic Foundation, OH 44195, USA
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212
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Abstract
The benign superior vena cava syndrome is an uncommon medical emergency. We describe a case of the superior vena cava syndrome caused by suppurative mediastinal lymphadenitis. The organisms isolated from various cultures were group C beta-hemolytic Streptococcus, Fusobacterium species, Corynebacterium species, Eikenella corrodens, and Streptococcus milleri. These anaerobic bacteria are part of the normal flora of the upper respiratory tract and the oral cavity. Anterior mediastinoscopy through the right parasternal approach was used to drain the anterior mediastinal abscess and to establish the etiologic factor.
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Affiliation(s)
- D Roy
- Department of Internal Medicine, Providence Hospital, Southfield, Michigan, USA
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213
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Abstract
Metallic stents have been recently introduced for treating superior vena cava (SVC) obstruction. Dose data, in terms of dose-area product (DAP), from 44 patients referred for SVC stent placement on a digital unit have been retrospectively analysed in terms of their fluoroscopic and radiographic components. The mean DAP for the 44 examinations was 42 Gy cm2 and the effective dose was estimated to be 5.8 mSv. The fluoroscopic component was approximately 80%, with a mean screening time for these examinations of 17 min. The mean number of digital exposures was 86.
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Affiliation(s)
- D O'Driscoll
- Department of Radiology, Heartland's Hospital, Birmingham, UK
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214
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Tanigawa N, Sawada S, Mishima K, Okuda Y, Mizukawa K, Ohmura N, Toita T, Ogawa K, Kobayashi M, Kobayashi M. Clinical outcome of stenting in superior vena cava syndrome associated with malignant tumors. Comparison with conventional treatment. Acta Radiol 1998; 39:669-74. [PMID: 9817039 DOI: 10.3109/02841859809175494] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We analyzed the clinical outcome of treatment with the expandable metallic stent (EMS) for the superior vena cava (SVC) syndrome associated with malignant tumors, and the results were compared with those of radiotherapy. MATERIAL AND METHODS Of 33 patients with the SVC syndrome, 23 were treated by Gianturco EMS placement and 10 were treated by radiotherapy and/or chemotherapy alone. Of the 23 EMS patients, 11 had treatment before EMS placement and 12 had no treatment before EMS placement. RESULTS After stenting, the clinical symptoms disappeared in 78% (18/23) of the patients, i.e. in 50% of the patients with intraluminal tumors, and in 93% of those with extrinsic compression. The clinical symptoms improved in 80% of patients who received radiotherapy. The mean duration of survival was 145 days in patients who underwent stenting, and 146 days in those receiving radiotherapy. However, the survival period differed significantly between patients with intraluminal tumors (44.9 days) and those with extrinsic compression (198.6 days). Between patients with previous treatment and those with no previous treatment, there was no significant difference in response rate or in survival period which were 82% versus 75%, and 127 days versus 162 days, respectively. CONCLUSION The clinical symptoms showed similar improvement in patients receiving EMS placement or radiotherapy. EMS placement was effective in relieving clinical symptoms in patients who had failed to respond to radiotherapy.
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Affiliation(s)
- N Tanigawa
- Department of Radiology, University Hospital of the Ryukyus, Okinawa, Japan
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215
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Camp-Sorrell D, Mayo DJ. Superior vena cava syndrome. Clin J Oncol Nurs 1998; 2:153-4. [PMID: 10232164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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216
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Jacobs P, Wood L, du Toit JM, Bergman JW, Baker PM. Chest pain as the presenting symptom in catheter-associated thrombosis of the superior vena cava. S Afr Med J 1998; 88:1284-5. [PMID: 9807173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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217
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Uchita S, Hata T, Tsushima Y, Matsumoto M, Hina K, Moritani T. Primary cardiac angiosarcoma with superior vena caval syndrome: review of surgical resection and interventional management of venous inflow obstruction. Can J Cardiol 1998; 14:1283-5. [PMID: 9852942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Primary cardiac angiosarcoma occurs rarely, and surgical resection is often required to relieve symptoms. A 66-year-old man whose presenting symptoms were palpitations and general fatigue is presented. Echocardiography revealed a large tumour occupying most of the right atrium. When superior vena caval (SVC) syndrome developed, surgical resection of the tumour was attempted. The tumour was found to have invaded the inflow of SVC, left atrium, right ventricle and ascending aorta. The bulk of the tumour was resected, requiring reconstruction of the right atrium and caval inflows. Histopathological diagnosis of the tumour was primary angiosarcoma. In the postoperative period, symptoms of SVC syndrome recurred, which were relieved temporarily by balloon angioplasty. After one month, recurrence of symptoms was again managed by catheter dilation. On this occasion a metallic stent was deployed, which prevented further symptoms of SVC syndrome during the eight months before the patient died with generalized metastases.
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Affiliation(s)
- S Uchita
- Department of Cardiovascular Surgery and Cardiology, Cardiac Centre SAKAKIBARA Hospital, Okayama, Japan.
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218
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Sze DY, Robbins RC, Semba CP, Razavi MK, Dake MD. Superior vena cava syndrome after heart transplantation: percutaneous treatment of a complication of bicaval anastomoses. J Thorac Cardiovasc Surg 1998; 116:253-61. [PMID: 9699577 DOI: 10.1016/s0022-5223(98)70124-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Our objectives were (1) to investigate the incidence and cause of symptomatic superior vena caval anastomotic stenosis and central venous thrombosis in patients receiving heart or heart-lung transplantation and (2) to explore percutaneous methods of thrombolysis and endoluminal intervention to treat these complications. METHODS Review of 1016 cases revealed three cases of superior vena cava syndrome. Anatomy, surgical technique, and medical risk factors were examined. Percutaneous treatments, including urokinase thrombolysis, mechanical thrombolysis, balloon angioplasty, and stent placement, were attempted. RESULTS All three of these patients underwent transplantation by means of the bicaval anastomotic technique. In addition, the diameters of the donor and recipient cavae were grossly mismatched in all three. Stenoses in all three patients were successfully treated percutaneously with balloon angioplasty and stent placement. Treatment of the accompanying large-volume thrombosis was problematic in these patients, and two had hemorrhagic complications of urokinase thrombolysis. A mechanical thrombolysis device was used successfully in the third patient. CONCLUSIONS Anastomotic stricture and central venous thrombosis is an uncommon complication of the bicaval anastomotic technique of heart and heart-lung transplantation. Discrepancy between donor and recipient caval diameters appears to be the major risk factor. Endoluminal thrombolysis and stenting provides rapid and enduring relief of symptoms and precludes repeat sternotomy, cardiopulmonary bypass, and general anesthesia.
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Affiliation(s)
- D Y Sze
- Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, Calif 94305-5450, USA
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219
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Ing FF, Mullins CE, Grifka RG, Nihill MR, Fenrich AL, Collins EL, Friedman RA. Stent dilation of superior vena cava and innominate vein obstructions permits transvenous pacing lead implantation. Pacing Clin Electrophysiol 1998; 21:1517-30. [PMID: 9725149 DOI: 10.1111/j.1540-8159.1998.tb00238.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to assess the feasibility of stent dilation of venous obstructions/occlusions to permit transvenous pacing lead implantation. Innominate vein or superior vena cava (SVG) obstruction may preclude the implantation of transvenous pacing leads. Patients with d-transposition of the great arteries, after a Mustard or Senning procedure, and children with previously placed transvenous pacing leads are at higher risk for this vascular complication. From May 1993 to January 1996, eight pediatric patients who underwent transvenous pacing lead implantation or replacement were found to have significant innominate vein or SVC obstruction or occlusion. Utilizing intravascular stents, a combined interventional and electrophysiological approach was used to relieve the venous obstruction and to permit implantation of a new transvenous pacing lead. Two patients had complete SVC occlusion requiring puncture through the obstruction with a transseptal needle. Vessel recanalization was achieved with balloon dilation and stent implantation. The remaining six patients had severe venous obstruction with a mean minimum diameter of 3.1 +/- 3.3 mm. The mean pressure gradient across the obstructed veins was 8.6 +/- 7.3 mmHg. Following implantation of 15 Palmaz P308 stents in eight vessels, the mean diameter increased to 14.2 +/- 1.9 mm and the mean pressure gradient across the stented vessels decreased to 1.0 +/- 2.0 mmHg. A transvenous pacing lead was implanted successfully through the stent(s) immediately or 6-8 weeks later. Innominate vein and SVC obstruction can be safely and effectively relieved with intravascular stents and permit immediate or subsequent transvenous pacing lead implantation.
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Affiliation(s)
- F F Ing
- Department of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, USA
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220
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McWilliams RG, van Oosthayen J, de Berg JC, Schultze Kool LJ. Gianturco Z stents and the Hydrolyser catheter: a potential problem. J Vasc Interv Radiol 1998; 9:465-7. [PMID: 9618107 DOI: 10.1016/s1051-0443(98)70300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- R G McWilliams
- Department of Radiology, St James's University Hospital, Leeds, England
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221
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Mahmud AM, Teshima T, Isawa T, Miki M, Horikoshi M, Yanagimachi T, Nukiwa T. Follow-up of patients with superior vena cava syndrome by functional analysis of radionuclide venography. Nucl Med Commun 1998; 19:417-26. [PMID: 9853330 DOI: 10.1097/00006231-199805000-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In addition to imaging, radionuclide venography can be used for studying haemodynamic changes in superior vena cava syndrome (SVCS) by using the indices of transit time (TT), time of half peak count (TH) and peak count ratio (PC ratio). The objective of this study was to examine the utility of applying these indices, alongside images, in the post-therapy assessment of SVCS patients. Radionuclide venography was performed twice on 36 patients with SVCS due to thoracic malignancies, 29 of whom received specific anti-cancer therapy between the two studies (Group I); the other 7 did not receive such therapy (Group II). On the images, 12 patients in Group I showed improvement, one a deterioration and 16 no change; in Group II, 4 showed a deterioration and 3 no change. Using the indices, nearly all patients in Group I had decreased post-therapy values indicating haemodynamic improvement. A significant difference was seen between the mean (+/- S.E.) pre- and post-therapy values for TT (pre vs post: 6.2 +/- 0.7 vs 2.7 +/- 0.3 s) and TH (pre vs post: 16.9 +/- 2.3 vs 7.9 +/- 0.8 s) (P < 0.001). Although the PC ratio showed a non-significant decrement, it related to the status of collateral change. The above indices provide clinically valuable information about the haemodynamic status of patients with SVCS and can be used for their post-therapy evaluation.
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Affiliation(s)
- A M Mahmud
- Department of Respiratory Oncology and Molecular Medicine, Tohoku University, Sendai, Japan
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222
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Affiliation(s)
- A Pop
- Section of Gastroenterology, Sinai Hospital, Detroit, Michigan 48235, USA
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223
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Rosa Brusin MC, Checco L, De Bernardi A, Morello M, Mangiardi L. [The superior vena cava obstruction syndrome after the implantation of a permanent pacemaker: a clinical case report]. Cardiologia 1998; 43:201-4. [PMID: 9557377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Occlusion of the superior vena cava is a rare but serious complication of transvenous endocardial pacing. We describe 1 case of superior vena cava obstruction associated with permanent transvenous DDD pacemaker, following local infection. Thrombolytic therapy was initially effective, resulting in relief of signs of obstruction. However systemic infection occurred 3 months later. The patient was subsequently submitted to surgical removal of the infected pacemaker apparatus. Several therapeutical options described in previous papers are reviewed: anticoagulants, thrombolytics, percutaneous dilatation, surgical removal of the catheter. In conclusion, when a chronic process induced by local infection is present, surgical treatment is the best therapeutical approach.
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Affiliation(s)
- M C Rosa Brusin
- Dipartimento di Medicina Interna, Ospedale San Giovanni Battista della Città di Torino
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224
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225
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Abstract
Superior vena cava syndrome (SVCS) is a distressing manifestation of benign or malignant disease obstructing return of blood flow through the superior vena cava (SVC). Treatment, often centering around management of the underlying illness, may be slow in relieving symptoms, relying on the recruitment of collateral veins to reestablish blood flow. Percutaneous delivery of metallic stents into the vena cava has been used with success to relieve obstruction to blood flow quickly and completely. We present the case of a patient with complete occlusion of the SVC who underwent successful vena caval revascularization with placement of balloon expandable metallic stents. We also review published reports on the use of stents for SVCS. Results from several series demonstrate that stents can be used with excellent results. Response rates in these series reviewed range from 68% to 100%. Recurrence of symptoms occurred in 4% to 45% of patients but could often be treated with anticoagulation, angioplasty of the stented area, or repeat stenting. Stenting has been used successfully in patients with malignant diseases and in the less common cases of SVCS from a benign etiology. Complications are uncommon and usually of minor consequence. Anticoagulation, thrombolytics, and thrombectomy or atherectomy catheters have also been used during or following stent implantation although their use remains primarily empiric. Percutaneous treatment of SVC obstruction offers patients hope for prompt and dramatic relief from the symptoms of SVCS.
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Affiliation(s)
- J Hochrein
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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226
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Kee ST, Kinoshita L, Razavi MK, Nyman UR, Semba CP, Dake MD. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement. Radiology 1998; 206:187-93. [PMID: 9423671 DOI: 10.1148/radiology.206.1.9423671] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate use of catheter-directed thrombolysis and/or endovascular stent placement to treat superior vena cava (SVC) syndrome. MATERIALS AND METHODS Fifty-nine consecutive patients with SVC syndrome were studied. The cause was underlying malignancy in 43 and benign disease in 16. All patients underwent bilateral upper-extremity venography. The SVC was occluded in 31 cases and stenosed in 28. Twenty-seven patients underwent catheter-directed thrombolysis; 51 underwent endovascular stent placement. Patency was defined in terms of absence of symptoms and signs of SVC syndrome. RESULTS Technical success was achieved in 56 of 59 patients (95%). Among 42 patients with underlying malignancy (mean follow-up, 7.0 months; range, 1-34 months), primary clinical patency was achieved in 33 (79%) and secondary clinical patency was achieved in 39 (93%). Among 13 patients with benign disease (mean follow-up, 17.0 months; range, 1-27 months), primary clinical patency was achieved in 10 (77%) and secondary clinical patency was achieved in 11 (85%). Four patients were lost to follow-up. Periprocedural mortality and morbidity rates were 3% (two of 59 patients) and 10% (six of 59 patients), respectively. CONCLUSION Catheter-directed thrombolysis and endovascular stent placement is a safe and effective treatment for SVC syndrome.
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Affiliation(s)
- S T Kee
- Department of Radiology, Stanford University Medical Center, CA 94305-5105, USA
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227
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228
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Abstract
Late systemic venous baffle obstruction after Mustard repair for complete transposition of the great arteries is a recognized complication. Balloon-expandable intravascular stents have previously been used to relieve systemic baffle narrowing in children. We report a successful stent implantation to relieve symptomatic superior vena cava obstruction and baffle dehiscence after Mustard repair in an adult patient. She had been turned down for surgery due to right ventricular dysfunction. Eighteen months after the procedure, she remains symptomless.
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Affiliation(s)
- F Benito
- Sección de Hemodinámica, Hospital La Paz, Madrid
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229
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Nicholson AA, Ettles DF, Arnold A, Greenstone M, Dyet JF. Treatment of malignant superior vena cava obstruction: metal stents or radiation therapy. J Vasc Interv Radiol 1997; 8:781-8. [PMID: 9314368 DOI: 10.1016/s1051-0443(97)70660-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The results of treating malignant superior vena cava obstruction by means of percutaneous self-expanding stent insertion or by means of radiation therapy were compared. PATIENTS AND METHODS Seventy-six patients with malignant superior vena cava obstruction who were treated by stent insertion were studied prospectively and 25 patients who were treated by radiation therapy were studied retrospectively. A superior vena cava obstruction score was devised to measure treatment effectiveness. Speed of symptom relief and complications were recorded. End points in the study were recurrent obstruction or death. Asymptomatic survival times were compared by log rank and Mann Whitney tests of significance, as well as Kaplan-Meier analysis. A subgroup of 26 patients who were treated by stent placement only were compared with the radiation therapy group and analyzed separately. RESULTS There were seven complications in the overall stent group, one in the stent-only group, and 25 in the radiation therapy group. Stent insertion provided faster relief of symptoms and significantly greater improvement in the superior vena cava obstruction score than radiation therapy (P < .001, Mann-Whitney U test). A Kaplan-Meier analysis of asymptomatic survival demonstrated that significantly fewer patients in the overall and stent-only groups developed recurrent symptoms (P = .0005 and .001, respectively, log rank test). CONCLUSION This study suggests that percutaneous stent insertion in malignant superior vena cava obstruction fulfills the requirements of a palliative procedure significantly better than radiation therapy and that it should be the procedure of first choice.
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Affiliation(s)
- A A Nicholson
- Department of Vascular Radiology, Royal Hull Hospitals Trust, England
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230
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Gross CM, Krämer J, Waigand J, Uhlich F, Schröder G, Thalhammer C, Dechend R, Gulba DC, Dietz R. Stent implantation in patients with superior vena cava syndrome. AJR Am J Roentgenol 1997; 169:429-32. [PMID: 9242747 DOI: 10.2214/ajr.169.2.9242747] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the feasibility of using Wallstent implantation to treat superior vena cava syndrome due to malignant tumors. SUBJECTS AND METHODS Digital subtraction angiography showed obstruction of the superior vena cava in 13 patients who then underwent transluminal dilatation and Wallstent implantation. The patients were treated with IV heparin and monitored in the emergency department. Thereafter, they were treated with a platelet inhibitor for 4 weeks. RESULTS Because their signs and symptoms improved, patients were able to resume radiation therapy, chemotherapy, or both. One patient died of cardiac arrhythmia 1 day after stent placement. Although eight patients have subsequently died of their bronchial or thyroid gland tumors, superior vena cava syndrome did not recur in any patient. CONCLUSION Percutaneous implantation of Wallstent endoprostheses provides excellent palliation for superior vena cava syndrome.
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Affiliation(s)
- C M Gross
- Department of Cardiology, Angiology and Pulmology, Franz Volhard Clinic at the Max Delbrück Center for Molecular Medicine, Humboldt University, Berlin, Germany
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231
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Chacón López-Muñiz JI, García García L, Lanciego Pérez C, Cruz Mora MA, García Peris A, Martínez Martínez B, López Gómez L. Treatment of superior and inferior vena cava syndromes of malignant cause with Wallstent catheter placed percutaneously. Am J Clin Oncol 1997; 20:293-7. [PMID: 9167757 DOI: 10.1097/00000421-199706000-00018] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Superior vena cava syndrome (SVCS) and inferior vena cava syndrome (IVCS) represent a severe symptomatic complication of some malignant tumors. Although radiation therapy and chemotherapy are elective, symptomatic relief takes 7-10 days to be achieved, and poor symptomatic benefit can be obtained in relapsed or resistant tumors. We report on a palliative approach using Wallstent catheters placed percutaneously in a series of 16 patients. Results obtained in relief of symptoms were excellent (complete response of cephalea, jugular enlargement, and collateral circulation achieved in 100% [16/16] of patients; complete response of edema obtained in 93% [15/16] of patients). Achievement of symptomatic response was obtained for all symptoms during the first 24 h poststenting, except for edema and dyspnea. Mean duration of patency of the stents was 6.4 months (range 2-17 months). Rates of morbidity and complications were very low. Dyspnea was a quite resistant symptom, and only four of 13 patients (31%) obtained complete response, while partial improvement was obtained in the other nine (79%). However, placement of the stents does not preclude the use of radiation therapy or chemotherapy. We think that these results and those from other studies warrant larger multicentric trials.
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232
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Abstract
The management of diabetes mellitus is often complicated in patients with advanced cancer. Anorexia and nausea or vomiting make caloric intake erratic. The use of diabetogenic medications such as glucocorticoids can produce profound hyperglycemia. Many malignant tumors cause derangement in intermediary metabolism and abnormal glucose tolerance in up to one-third of patients. Both hyperglycemia and hypoglycemia impair the quality of life of dying patients. Swings in blood sugar should be avoided wherever possible, but aggressive blood sugar monitoring also impairs quality of life. This paper discusses issues in the management of diabetes in patients with advanced cancer and suggests guidelines for maintaining glycemic control without excessive interventions.
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Affiliation(s)
- J Poulson
- Department of Medicine, University of Toronto, Ontario, Canada
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233
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Smith SJ, Vyborny CJ, Hines JL. Re: chronic superior vena cava occlusion related to fibrosing mediastinitis treated with self-expanding shunts. Cardiovasc Intervent Radiol 1997; 20:161-2. [PMID: 9030512 DOI: 10.1007/s002709900128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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234
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Takao M, Shimamoto A, Adachi K, Tokui T, Shimono T, Namikawa S, Yuasa H, Yada I, Murashima S. [Treatments for T4 advanced lung cancer with invasion to the superior vena cava]. Kyobu Geka 1997; 50:101-5. [PMID: 9028065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We discussed on the treatments for T4 lung cancer with invasion to the superior vena cava, whose prognosis has been poor. However, surgical resection may improve the prognosis compared with radiation therapy. The prosthetic replacement of superior vena cava can be done safely, and its patency is good in cases of ring-enforced ePTFE graft. Although superior vena caval obstruction syndrome had been a hard issue in the advanced cases, stenting in superior vena using the interventional radiological technique is a safe and reliable method. We should consider the stenting as the first choice for superior vena cava obstruction syndrome, because it makes the QOL improve so much.
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Affiliation(s)
- M Takao
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Japan
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235
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Abstract
Superior vena cava obstruction (SVCO) is a distressing syndrome. The condition may present to specialists in many branches of medicine, but patients have traditionally been referred on to clinical oncologists for management, as malignancy is the main aetiological factor. Treatment without a histological diagnosis is no longer justified, because management needs to be tailored to the underlying disease. This article reviews the causes, symptoms, methods of diagnosis and therapy options. The role of stenting in SVCO is discussed and a management algorithm is proposed.
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Affiliation(s)
- P J Ostler
- Meyerstein Institute of Oncology, Middlesex Hospital, London, UK
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236
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Abstract
Obstruction of the systemic venous pathway is a complication in patients who have undergone the Mustard operation for complete transposition of the great arteries. In this report, we discuss intravascular stent placement in three patients for relief of superior vena caval obstruction after the Mustard operation. The clinical history, cardiac catheterization data, and echocardiographic data before and after stent placement are presented for each patient. Overall, four stents were placed. The mean gradients from the superior vena cava to the right atrium before stent placement were 10, 8, and 6 mm Hg, and they decreased to 3, 0, and 1 mm Hg immediately after stent placement. No complications occurred. Doppler echocardiographic assessment of mean gradients before and after stent placement correlated with the mean gradients determined by cardiac catheterization. Intravascular stent placement is effective for relief of baffle obstruction after the Mustard operation. Serial Doppler assessments of the gradient across the stent offer a noninvasive method for follow-up of these patients.
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237
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Abstract
OBJECTIVES To review the clinical presentation, pathophysiology, diagnosis, treatment, and nursing care of superior vena cava syndrome (SVCS). DATA SOURCES Journal articles, research studies, and book chapters relating to complications of lung cancer and SVCS. CONCLUSION Lung cancer is the most common malignancy associated with SVCS. The onset of symptoms may be gradual or rapid. Treatment of SVCS is based on the etiology and histologic diagnosis. IMPLICATIONS FOR NURSING PRACTICE Major considerations in the nursing care of patients with SVCS include recognition of high-risk patients, facilitation and coordination of diagnostic procedures, assessment of respiratory, cardiac and neurologic systems, administration of therapy, provision of emotional and psychosocial support, and patient education.
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Affiliation(s)
- I E Stewart
- Section of Medical Oncology, Rush Cancer Institute, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL, USA
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238
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Marlier S, Bonal J, Cellarier G, Bouchiat C, Talard P, Dussarat GV. [Superior vena cava syndromes of benign etiology]. Presse Med 1996; 25:1203-7. [PMID: 8949625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Superior vena cava syndromes are uncommon and usually caused by malignant diseases. In about 20% of the cases however, the cause is benign. Besides chronic mediastinitis, a growing number of cases are reported of thrombosis resulting from endovenous devices (central catheters, pacemaker leads...). Onset is often slow and insidious, good tolerance in the early stages being explained by the development of an effective collateral circulation. Bibrachial phlebography is still the reference exploration, but computed tomography and magnetic resonance imaging are contributive to diagnosis. Symptoms usually regress after medical treatment, sometimes requiring thrombolysis, however, in 10% of the patients, major functional impairment may require bypass surgery (autologous graft or endoprosthesis) or transluminal angioplasty. There is still some debate as to the precise indications for each method, but angioplasty, used recently, appears to be the most interesting technique for a disease in which prognosis is almost always favorable.
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Affiliation(s)
- S Marlier
- Service de Pathologie cardio-vasculaire, Hôpital d'Instruction des Armées Sainte-Anne, Toulon
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239
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Entwisle KG, Watkinson AF, Reidy J. Case report: migration and shortening of a self-expanding metallic stent complicating the treatment of malignant superior vena cava stenosis. Clin Radiol 1996; 51:593-5. [PMID: 8761401 DOI: 10.1016/s0009-9260(96)80144-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- K G Entwisle
- Department of Diagnostic Radiology, Guy's Hospital, London, UK
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240
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Abstract
The treatment of patients with malignant superior vena caval obstruction with minimal morbidity has been made possible by the recent introduction of expandable metal stents as the sole palliative treatment or as an adjunct to other treatment modalities. To alleviate the distressing symptoms of superior vena caval obstruction, self-expanding metal stents were used successfully in 12 (Wallstent device in 6 and Gianturco device in 6 patients) of 13 patients. The diagnoses were small cell carcinoma (n = 4), squamous cell carcinoma (n = 4), non-Hodgkin's lymphoma (n = 1), and mesothelioma (n = 1), and a diagnosis of malignancy was not confirmed (although strongly suspected) in the remaining three cases. Eleven patients had immediate relief of obstruction and there was no change in one patient. Mean follow-up was 3.7 months (range 1 to 10 months). Excellent palliation was obtained in all but one patient in whom recurrent superior vena caval obstruction developed 3 months after stenting. Mean survival was 4.8 months (range 1 to 10 months). The ease of insertion with the use of local anesthesia with radiologic control, the self-expanding nature of the stent, and the lack of major complications on follow-up of up to 10 months are particular advantages. The self-expanding superior vena caval stents are a useful addition to our armamentarium in the management of malignant superior vena caval obstruction.
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Affiliation(s)
- R Shah
- Department of Thoracic Surgery, Bradford Royal Infirmary, United Kingdom
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241
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Abstract
We report the use of a Dacron-covered Gianturco-Rösch Z (GRZ)-stent to treat malignant obstruction of the superior vena cava (SVC). Initial treatment with an uncovered GRZ-stent was suboptimal due to protrusion of tumor-thrombus through the stent struts into the SVC lumen. Placement of a coaxial Dacron-covered stent graft relieved the residual obstruction due to tumor within the SVC.
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Affiliation(s)
- D H Chin
- Dotter Interventional Institute, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd., L-605, Portland, OR 97201-3098, USA
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242
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Abstract
We reported the use of a new miniature biplane TEE probe during pediatric cardiac interventional catheterization procedures. Use of this imaging modality provided significant advantages during dilation of obstructed venous pathways and closure of interatrial defects. Procedural characteristics and specific congenital heart lesion-related advantages were discussed.
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Affiliation(s)
- D E Douglas
- South Carolina Children's Heart Center, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, USA
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243
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Schranz D, Michel-Behnke I, Schmid FX, Oelert H. [Intravascular stents for treatment of systemic venous obstructions]. Z Kardiol 1996; 85:477-81. [PMID: 8928545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two young adults, 16 and 18 years of age were admitted with complete occlusion of the superior vena cava pathway following previous Mustard procedure. In both patients, perforation of complete occluded vein segment using a straight guidewire and subsequent sequential enlargement by balloon dilation were successfully performed by a left subclavian vein approach. Implantation of a 30 mm Palmaz-stent resulted in a widely patent channel of the vena cava superior into the systemic venous atrium. In short-term follow-up of 3 months both stents remained patent. Repeat dilation of the stents was performed after 3 months. A third patient with systemic venous obstruction was a 3-year old child who suffered low cardiac output following modified Fontan operation caused by a narrowing of the superior vena cava to right pulmonary artery connection and stenosis of distal left pulmonary artery. The severe hemodynamic problem was resolved by implantation of Palmaz-stents in the two separate obstructions. At recatheterization 6 months later, both stents were patent without any residual pressure gradient.
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Affiliation(s)
- D Schranz
- Kinderkardiologie, Universitätskinderklinik, Mainz
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244
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Affiliation(s)
- A B Fontaine
- Department of Radiology, Ohio State University Medical Center, Columbus 43210, USA
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245
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Schranz D, Michel-Behnke I, Schmid FX, Oelert H. Gradual angioplasty and stent implantation to treat complete superior vena cava occlusion after Mustard procedure. Cathet Cardiovasc Diagn 1996; 38:87-90; discussion 91. [PMID: 8722867 DOI: 10.1002/(sici)1097-0304(199605)38:1<87::aid-ccd20>3.0.co;2-o] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 16-year-old male was admitted with complete occlusion of the superior vena cava pathway 14 years after Mustard procedure for transposition of the great arteries. From a left subclavian vein approach, the atretic vein segment was perforated using a straight guidewire, and was followed by sequential balloon dilation. Implantation of a 30 mm Palmaz-stent through a femoral vein approach resulted in a widely patent channel of the vena cava superior into the systemic venous atrium.
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Affiliation(s)
- D Schranz
- Department of Pediatric Cardiology, University of Mainz, Germany
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246
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Oudkerk M, Kuijpers TJ, Schmitz PI, Loosveld O, de Wit R. Self-expanding metal stents for palliative treatment of superior vena caval syndrome. Cardiovasc Intervent Radiol 1996; 19:146-51. [PMID: 8846480 DOI: 10.1007/bf02577610] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Two stent types (a new Wallstent and a Z-stent) were investigated in 30 patients with recurrent malignant superior vena caval syndrome (SVCS). METHODS Eligibility requirements were that the patient had recurrent symptoms after appropriate radiation therapy, chemotherapy, or both; >/= 75% of the vessel was occluded; and there was collateral flow. Because of the limited availability of stents, it was not possible to perform a prospectively randomized study. RESULTS In the Z-stent group (17 patients), occlusion of the stent due to acute thrombosis occurred within 12 hr in 4 patients (24%), but in the other 13 patients (76%) symptoms disappeared completely. After 2 weeks the cavogram in these patients showed no signs of thrombosis, and 12 (61%) of the patients remained symptom-free. There was partial occlusion in 5 patients (29%), without relevant clinical symptoms. Of the 13 patients who received Wallstents, only 1 had an acute immediate thrombosis (8%). Symptoms disappeared completely in the other 12 patients and no signs of thrombosis were seen. However, after 2 weeks complete stent occlusion with SVCS was found in 3 patients (23%) and partial occlusion with minor clinical symptoms in 6 (46%). Only 3 patients (23%) had complete relief of the SVCS. The difference between the rates of occlusion of the two stents after 2 weeks was highly significant (p = 0.008). CONCLUSIONS The overall clinical success rate for long-term patency was 100% for the Z-stents and 69% for the new Wallstent. These results suggest that when used for this purpose, the new Wallstent is more thrombogenic at 2 weeks than the Z-stent.
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Affiliation(s)
- M Oudkerk
- Department of Radiodiagnostics, Dr. Danile den Hoed Cancer Center/University Hospital Rotterdam, Rotterdam, The Netherlands
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247
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Hemphill DJ, Sniderman KW, Allard JP. Management of total parenteral nutrition-related superior vena cava obstruction with expandable metal stents. JPEN J Parenter Enteral Nutr 1996; 20:222-7. [PMID: 8776698 DOI: 10.1177/0148607196020003222] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Catheter-related thrombotic and stenotic obstructions are the second most common serious complication of long-term total parenteral nutrition. Subsequent venous access problems have profound implications because of immediate and long-term requirements of nutrition support. Although improved understanding of pathogenesis has led to improved prophylaxis and treatment of thrombosis, some patients will have refractory obstructions that threaten venous access and lead to severe clinical sequelae, including superior vena cava (SVC) syndrome. We describe two cases of patients with SVC syndrome refractory to anticoagulant, thrombolytic, and balloon angioplasty therapy, managed successfully with percutaneous placement of expandable metal stents. A discussion of the current understanding of prophylaxis and treatment of catheter-related thrombosis and the role for interventional measures to restore venous patency and avoid permanent venous access problems accompanies the case descriptions.
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Affiliation(s)
- D J Hemphill
- Department of Medicine, Toronto Hospital, Ontario, Canada
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248
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Abstract
This is a case report of pacemaker-induced superior vena cava syndrome in which the patient was successfully treated with balloon venoplasty. Six-month follow-up demonstrates angiographic patency and resolution of symptoms.
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Affiliation(s)
- R J Kastner
- National Naval Medical Center, Division of Cardiovascular Diseases, Bethesda, Maryland 20889-5600, USA
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249
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Fuyuno G, Kobayashi R, Iga R, Nomori H, Horio H, Morinaga S, Kodera K. [Use of an expandable metallic stent in patients with superior vena cava syndrome--comparison of angiographic findings and autopsy findings]. Nihon Kyobu Shikkan Gakkai Zasshi 1996; 34:304-11. [PMID: 8778470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To evaluate the usefulness of expandable metallic stens (EMS) in patients with superior vena cava (SVC) syndrome, we compared venographic findings obtained before EMS insertion with findings at autopsy. Stents were inserted into the SVC in 10 patients. An autopsy was done in 7 of the 10 patients. At autopsy, the lumen of the SVC was patent in 4 patients; in those 4 patients venography before EMS insertion showed that the SVC was obstructed by extramural compression. These results suggest that extramural compression without direct invasion of the tumor is the best indication for insertion of an EMS. At autopsy, the lumen of the SVC was obstructed by direct invasion of a tumor in 2 patients; in those 2 patients venography showed wall irregularity and lumen narrowing caused by tumor invasion. However, in those 1 patients SVC syndrome either did not recur or recurred in only a mild form after EMS insertion. The results in these 2 patients suggest that if collateral circulation does not develop, insertion of an EMS is indicated also in patients in whom the SVC is obstructed by direct invasion of a tumor. In the remaining patient, the lumen of the SVC was found at autopsy to be obstructed by a thrombus. SVC syndrome developed in this patient 430 days after EMS insertion. In 1 of the 7 patients, an EMS was inserted into the left innominate vein and also into the SVC. Venography before EMS insertion showed that the vein was obstructed by extramural compression without direct invasion of the tumor, but the EMS was found at autopsy to be completely obstructed by a thrombus. This suggests that insertion of an EMS into the left innominate vein is not indicated this vein is easily obstructed by thrombi because of its anatomical location.
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Affiliation(s)
- G Fuyuno
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Japan
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250
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Witt C, Romaniuk P, Ewert R, Borges AC, John M, Kausch S, Baumann G. [Interventional pneumology: procedures for pulmonary hemorrhage and tumor-induced superior vena cava syndrome]. Pneumologie 1996; 50:202-8. [PMID: 8868594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Interventional pneumology includes both bronchological and vascular methods of diagnostic and therapy, especially in case of pneumological emergency, such as pulmonary hemorrhage and superior vena cava syndrome. In massive pulmonary hemorrhage bronchological diagnosis is needed to determine the location and activity of the bleeding, as well as angiography of bronchial arteries, and of pulmonary arteries, respectively. Bronchus occlusion by aid of balloon catheter or double lumen tube are intermediate methods to bridge over till defenitive surgery or embolisation of bronchial or pulmonal arteries as complementary methods in patients with pulmonary hemorrhage. In patients suffering from superior vena cava syndrome caused by neoplasms venous angioplasty and Wallstent implantation provide immediate clinical improvement.
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Affiliation(s)
- C Witt
- Medizinische Fakultät der Humboldt-Universität zu Berlin, Universitätsklinikum Charité
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