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Maleux G, Claus E, Laenen A, Buyck PJ, Claes K, Bonne L, Nackaerts K, Dooms C. Newly Designed, Self-Expanding Large-Bore Nitinol Stents for Symptomatic Central Venous Stenosis: Technical and Long-Term Clinical Outcome. Cardiovasc Intervent Radiol 2024; 47:1200-1209. [PMID: 39134807 DOI: 10.1007/s00270-024-03820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/18/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE To retrospectively analyze the technical and long-term clinical outcome of angioplasty and stenting using the Venovo™ venous stent for the treatment of malignant and benign superior vena cava (SVC) occlusive disease. MATERIALS AND METHODS Consecutive patients treated with the Venovo™ venous stent for SVC occlusive disease were included. SVC obstruction symptoms were classified according to the Kishi score. The Wilcoxon signed-rank test was used for testing significance of changes. Technical success, defined as correct placement of the stent, completely covering and re-expanding the obstruction, between groups was tested using the Fisher exact test. Overall survival was calculated using the Kaplan-Meier method. RESULTS Fifty-five patients underwent stent insertion for symptomatic benign (n = 13; 24%) or malignant (n = 42; 76%) SVC occlusive disease. A significant drop in Kishi score, mean 3.91 before versus mean 1.02 after the procedure (P < 0.0001), was observed. In one patient (1.8%), an additional balloon-expandable stent was needed to manage incomplete expansion of the nitinol stent. In one patient, a procedure-related lung embolic complication was noted. Early thrombotic occlusion of the stent occurred in one patient. Late symptomatic restenosis occurred in 3 patients. Overall primary stent patency and primary-assisted stent patency were 86% (95% CI 66-95) and 97% (95% CI 83-100) at 1-year follow-up and 98% (95% CI 87-100), 98% (87-100) at 2-year follow-up, respectively. CONCLUSION In this retrospective analysis, angioplasty and stent placement using the Venovo™ venous stent is safe and clinically effective for the treatment of both benign and malignant SVC occlusive disease. Reintervention for symptomatic restenosis is rare.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
| | - Eveline Claus
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre, Leuven, Belgium
| | - Pieter-Jan Buyck
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Kathleen Claes
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Kris Nackaerts
- Department of Respiratory Diseases, University Hospitals Leuven and BREATHE Research Group, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Christophe Dooms
- Department of Respiratory Diseases, University Hospitals Leuven and BREATHE Research Group, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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Yu Y, Xiong Y, Li T, Zhou J, Yan W, Xiong Y, Chen Y, Fu P. Risk factors for in-stent restenosis in maintenance hemodialysis patients with central venous occlusive disease and biomechanical assessment of stents. J Vasc Access 2024; 25:943-952. [PMID: 36540050 DOI: 10.1177/11297298221139640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES To investigate the risk factors and biomechanical mechanisms of in-stent restenosis (ISR) in central venous occlusive disease (CVOD). PATIENTS AND METHODS This retrospective study consecutively included 77 maintenance hemodialysis (MHD) patients with CVOD who received the first percutaneous transluminal angioplasty with stenting (PTS) due to symptomatic CVOD in a tertiary hospital. The mean age was 59.7 ± 14.0 years, and 51.9% of patients were male. The clinical characteristics, occurrence of ISR and patency rates were recorded. Finite element method was applied to assess the biomechanical properties of stents. RESULTS Among 77 patients with a mean CVS score of 8.0 ± 2.8, 20.8%, 62.3%, and 16.9% of patients had the main vein of CVOD in the subclavian vein, brachiocephalic vein, and superior vena cava, respectively. A total of 72 (93.5%) patients received successful PTS treatment, for which the stents implanted were mainly Fluency covered stent (48.6%) and SMART bare stent (31.9%). During 15 (10-24)-months of follow-up, ISR occurred in 36.1% of the 72 patients. The primary and assisted primary patency rates at 6, 12, and 18 months were 78%, 56%, 42% and 95%, 90%, 87%, respectively. A prolonged dialysis vintage was an independent risk factor for ISR, yet the stent type or the main vein location was not correlated with ISR. Among three laser-engraving stents, the SMART stent was the best in terms of flexibility, stress, and strain on stents but worst in stress or strain on vessels. The Luminexx stent was the best in radial force and worst in stress or strain on stents. The Vici stent was the best in stress and strain on vessels and worst in radial force and flexibility. CONCLUSIONS An unsatisfactory comprehensive biomechanical performance from configurations rooted in existing stents may account for the high incidence of ISR in CVOD.
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Affiliation(s)
- Yang Yu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Interventional Therapy Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yuqin Xiong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- College of Mechanical Engineering, Sichuan University, Chengdu, China
| | - Jingyuan Zhou
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Weijie Yan
- Division of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Xiong
- College of Mechanical Engineering, Sichuan University, Chengdu, China
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
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Rioja Artal S, González Martínez V, Royo Serrando J, Delgado Daza R, Moga Donadeu L. Results of Palliative Stenting in Malignant Superior Vena Cava Syndrome Analyzing Self-Expanding Stainless Steel and Nitinol Venous Bare Metal Stents. J Endovasc Ther 2024:15266028241242926. [PMID: 38676408 DOI: 10.1177/15266028241242926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
PURPOSE The purpose was to analyze the technical, clinical, and survival outcomes of our patients with malignant superior cava vein syndrome (SVCS) treated with endovascular approach and analyze the efficacy of different stent types used. MATERIAL AND METHODS It is an observational, retrospective, single-center study. From 2006 to 2023, 42 patients (32 male, 10 female, mean age 62 years, age range, 41-87 years) underwent percutaneous stent placement for malignant SVCS. One stainless steel stent (Wallstent) and 2 venous nitinol stent type (Sinus-XL, Venovo) were used. Follow-up mean was 276 days. RESULTS A total of 53 stents were deployed. Clinical success was 97.6% in less 24 hours. Technical success was achieved in 97.6%. No complications were found except 1 patient died during the procedure due to stent migration and atrial dissociation (2.3%). Overall intraprocedural stent migration rate was 11.9% (18.8% stainless steel stent, 9.6% nitinol stent, p>0.05). Overall survival rates were 87.8%, 41.99%, and 34.12%, and overall primary patency rates were 100%, 93.3%, 91.6% at 1, 6, and 12 months, respectively. CONCLUSIONS Endovascular treatment is a safe and effective therapeutic option for SVCS with high technical and clinical success rates and low complication and recurrence rates. CLINICAL IMPACT The malignant superior cava vein syndrome is a rare clinical entity treated classically with radiation and chemotherapy with a slower response, or surgical bypass, which is an aggressive surgical technique. Endovascular treatment offers a low-invasive technique with quick clinical resolution and good permeability results. However, further studies are lacking to deal with procedure technical characteristics, stent type used, technical complications, and medium- and long-term patency studies. This study aims to evaluate all these items, analysing self-expanding stainless steel and nitinol venous bare metal stents, and add value to endovascular treatment, confirming the good results of this technique.
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Affiliation(s)
- Sara Rioja Artal
- Department of Vascular Surgery, University Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Victor González Martínez
- Department of Vascular Surgery, University Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Josep Royo Serrando
- Department of Vascular Surgery, University Hospital Vall Hebron, University Autonoma Barcelona, Barcelona, Spain
| | - Rafael Delgado Daza
- Department of Vascular Surgery, University Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Lluis Moga Donadeu
- Department of Vascular Surgery, University Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain
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Shah RP, Bolaji O, Duhan S, Ariaga AC, Keisham B, Paul T, Aljaroudi W, Alraies MC. Superior Vena Cava Syndrome: An Umbrella Review. Cureus 2023; 15:e42227. [PMID: 37605686 PMCID: PMC10439982 DOI: 10.7759/cureus.42227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Superior vena cava syndrome (SVCS) is a medical emergency that encompasses an array of signs and symptoms due to obstruction of blood flow through the superior vena cava (SVC). It poses a significant healthcare burden due to its associated morbidity and mortality. Its impact on the healthcare system continues to grow due to the increasing incidence of the condition. This incidence trend has been attributed to the growing use of catheters, pacemakers, and defibrillators, although it is a rare complication of these devices. The most common cause of SVCS remains malignancies accounting for up to 60% of the cases. Understanding the pathophysiology of SVCS requires understanding the anatomy, the SVC drains blood from the right and left brachiocephalic veins, which drain the head and the upper extremities accounting for about one-third of the venous blood to the heart. The most common presenting symptoms of SVCS are swelling of the face and hand, chest pain, respiratory symptoms (dyspnea, stridor, cough, hoarseness, and dysphagia), and neurologic manifestations (headaches, confusion, or visual/auditory disturbances). Symptoms generally worsen in a supine position. Diagnosis typically requires imaging, and SVCS can be graded based on classification schemas depending on the severity of symptoms and the location, understanding, and degree of obstruction. Over the past decades, the management modalities of SVCS have evolved to meet the increasing burden of the condition. Here, we present an umbrella review providing an overall assessment of the available information on SVCS, including the various management options, their indications, and a comparison of the advantages and disadvantages of these modalities.
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Affiliation(s)
- Rajendra P Shah
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Olayiwola Bolaji
- Department of Internal Medicine, University of Maryland Capital Regional Medical Center, Largo, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Anderson C Ariaga
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Bijeta Keisham
- Sinai Center for Thrombosis and Research, Sinai Hospital of Baltimore, Baltimore, USA
| | - Timir Paul
- Section of Interventional Cardiology, University of Tennessee at Nashville/Ascension Saint Thomas Hospital, Nashville, USA
| | - Wael Aljaroudi
- Department of Cardiology, Augusta University Medical College of Georgia, Augusta, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, USA
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Wang Y, Li F, Hu Y, Sun Y, Tian C, Cao Y, Wang W, Feng W, Yan J, Wei J, Du X, Wang H. Clinical outcomes of intra-arterial chemotherapy combined with iodine-125 seed brachytherapy in the treatment of malignant superior vena cava syndrome caused by small cell lung cancer. Cancer Radiother 2023:S1278-3218(23)00068-9. [PMID: 37230904 DOI: 10.1016/j.canrad.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/29/2022] [Accepted: 01/14/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Currently there is a lack of effective treatment strategies for malignant superior vena cava syndrome (SVCS). We aim to investigate the therapeutic effect of intra-arterial chemotherapy (IAC) combined with the Single Needle Cone Puncture method for the 125I brachytherapy (SNCP-125I) in treating SVCS caused by stage III/IV Small Cell Lung Cancer (SCLC). MATERIALS AND METHODS Sixty-two patients with SCLC who developed SVCS from January 2014 to October 2020 were investigated in this study. Out of these 62 patients, 32 underwent IAC combined with SNCP-125I (Group A) and 30 patients received IAC treatment only (Group B). Clinical symptom remission, response rate, disease control rate, and overall survival of these two groups of patients were analyzed and compared. RESULTS The remission rate of symptoms including dyspnea, edema, dysphagia, pectoralgia, and cough of malignant SVCS in Group A was significantly higher than that in Group B (70.5 and 50.53%, P=0.0004, respectively). The disease control rates (DCR, PR+CR+SD) of Group A and B were 87.5 and 66.7%, respectively (P=0.049). Response rates (RR, PR+CR) of Group A and Group B were 71.9 and 40% (P=0.011). The median overall survival (OS) of Group A was significantly longer than that in Group B which was 18 months compared to 11.75 months (P=0.0360). CONCLUSIONS IAC treatment effectively treated malignant SVCS in advanced SCLC patients. IAC combined with SNCP-125I in the treatment of malignant SVCS caused by SCLC showed improved clinical outcomes including symptom remission and local tumor control rates than IAC treatment only in treating SCLC-induced malignant SVCS.
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Affiliation(s)
- Y Wang
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - F Li
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China; Core Laboratory, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China.
| | - Y Hu
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China; Shanxi Mecidal University, Graduate Research Institute, 030604 Shanxi, China
| | - Y Sun
- Department of Melanoma, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - C Tian
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - Y Cao
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - W Wang
- Department of Pathology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - W Feng
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - J Yan
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - J Wei
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - X Du
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - H Wang
- Department of Oncology, Tianjin Union Medical Center, 300191 Tianjin, China; Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
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Al Saadi W, Al Khalili H, Al Hajriy M. Superior vena cava syndrome-induced hemoptysis. Am J Med Sci 2023; 365:205-211. [PMID: 36152811 DOI: 10.1016/j.amjms.2022.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/26/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023]
Abstract
Superior vena cava (SVC) syndrome resulting from obstruction of the blood flow to the superior vena cava is rarely reported to present with life-threatening hemoptysis. The pathogenesis and the underlying mechanism are still not well described in the literature. We report a unique case of a 27-year-old man known to have end-stage kidney disease (ESKD) on hemodialysis that presented with shortness of breath and life-threatening hemoptysis that developed during the dialysis session. Computerized tomography with contrast (CTPA) confirmed the presence of a large, calcified thrombus within the SVC along with the formation of multiple collaterals which was diagnostic for SVC syndrome. Attempts for revascularization and stenting failed, and the patient had a prolonged and stormy course while admitted, including difficult alternative dialysis access that unfortunately resulted in death eventually. Here we are highlighting the importance of recognition of hemoptysis as a presentation of SVC syndrome by explaining the underlying pathogenesis and possible management options.
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Affiliation(s)
- Waleed Al Saadi
- Internal Medicine Department, Oman Medical Specialty Board, Muscat, Oman.
| | - Huda Al Khalili
- Internal Medicine Department, Oman Medical Specialty Board, Muscat, Oman; Anaesthesia and Critical Care Department, The Royal Hospital, Muscat, Oman
| | - Mahmood Al Hajriy
- Interventional Radiology, Radiology Department, The Royal Hospital, Muscat, Oman
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SEN I, KALRA M, GLOVICZKI P. Interventions for superior vena cava syndrome. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:674-681. [DOI: 10.23736/s0021-9509.22.12448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Shin DS, Jackson TR, Bertino FJ, Monroe EJ, Hage AN, Lee E, Ingraham CR, Vaidya S, Chick JFB. Kissing Viabahn VBX stent graft reconstruction of thoracic central veins for management of superior vena cava syndrome. J Vasc Surg Venous Lymphat Disord 2022; 10:1279-1287.e1. [PMID: 35843595 DOI: 10.1016/j.jvsv.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In the present study, we evaluated the technical and clinical outcomes of thoracic central vein reconstruction for superior vena cava (SVC) syndrome using kissing Viabahn VBX stent grafts (W.L. Gore & Associates, Flagstaff, AZ). METHODS All adult patients with SVC syndrome who had undergone attempted bilateral brachiocephalic vein-to-SVC reconstruction using kissing VBX stent grafts at an academic hospital between August 2019 and February 2021 were reviewed. The technical results, adverse events, imaging follow-up findings, and clinical outcomes were recorded. Patency over time was assessed using Kaplan-Meier analysis. RESULTS A total of 28 patients (16 women and 12 men; mean age, 52.0 years) constituted the study cohort. Of the 28 patients, 17 (60.7%) had had benign and 11 (39.3%) malignant etiologies. The presenting symptoms included neck swelling (n = 17; 60.7%), bilateral upper extremity swelling (n = 15; 53.6%), dyspnea (n = 7; 25%), unilateral upper extremity swelling (n = 4; 14.3%), and dysphagia (n = 1; 3.6%). SVC reconstruction with VBX stent grafts in a kissing configuration was successfully completed in 27 of the 28 patients (96.4%). Four major adverse events were noted in the benign etiology subgroup (23.5%), including intraprocedural hemopericardium (n = 3) and delayed pneumothorax (n = 1). Of the 28 patients, 27 (96.4%) had experienced resolution of their presenting symptoms. The mean clinical follow-up for the living patients was 358.8 ± 77.2 days (range, 78-645 days). The mean imaging follow-up for the living patients was 272.6 ± 91 days (range, 26-594 days). The primary, primary-assisted, and secondary patency rates at 12 months were 71.8%, 88.8%, and 100%, respectively. CONCLUSIONS For the management of SVC syndrome, thoracic central vein reconstruction with kissing VBX stent grafts was feasible with a high rate of symptom resolution and acceptable patency. However, this technique should not be recommended for those with benign SVC syndrome owing to the high risk of cardiac tamponade.
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Affiliation(s)
- David S Shin
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA; The Deep Vein Institute, University of Washington, Seattle, WA.
| | - Tyler R Jackson
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Frederic J Bertino
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Eric J Monroe
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, Madison, WI
| | - Anthony N Hage
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Eunjee Lee
- Department of Information and Statistics, Chungnam National University, Daejeon, South Korea
| | - Christopher R Ingraham
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Sandeep Vaidya
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Jeffrey Forris Beecham Chick
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA; The Deep Vein Institute, University of Washington, Seattle, WA
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Difficult Vascular Access in Children with Short Bowel Syndrome: What to Do Next? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050688. [PMID: 35626867 PMCID: PMC9139311 DOI: 10.3390/children9050688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 12/19/2022]
Abstract
Short Bowel Syndrome and intestinal failure are chronic and severe conditions that may require life-long parenteral nutrition in children. Survival of these children rely on the correct functioning of central venous catheters; therefore, careful management, prevention, and treatment of complications is of paramount importance. Despite a growing awareness of preserving the vascular real estate, a certain number of patients still experience a progressive and life-threatening exhaustion of vascular access. We searched the literature to highlight the current management of children with vascular exhaustion, specifically focusing on vascular access salvage strategies and last-resource alternative routes to central veins. Given the paucity of data, results are reported in the form of a narrative review.
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Aung EYS, Khan M, Williams N, Raja U, Hamady M. Endovascular Stenting in Superior Vena Cava Syndrome: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2022; 45:1236-1254. [PMID: 35821122 PMCID: PMC9458578 DOI: 10.1007/s00270-022-03178-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 05/15/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). METHODS MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper-Pearson estimation. RESULTS Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0-97.5%) and 92.8% (95% CI 91.7-93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0-93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). CONCLUSIONS This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. LEVEL OF EVIDENCE Level III, systematic review of retrospective cohort studies.
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Affiliation(s)
- Eri Yin-Soe Aung
- Imperial College School of Medicine, Imperial College London, Sir Alexander Fleming Building, Imperial College Road, London, SW72DD UK
| | - Maha Khan
- Imperial College School of Medicine, Imperial College London, Sir Alexander Fleming Building, Imperial College Road, London, SW72DD UK
| | - Norman Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, W1W 7JN UK
| | - Usman Raja
- Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
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Ponti A, Saltiel S, Rotzinger DC, Qanadli SD. Insights Into Endovascular Management of Superior Vena Cava Obstructions. Front Cardiovasc Med 2021; 8:765798. [PMID: 34901225 PMCID: PMC8652054 DOI: 10.3389/fcvm.2021.765798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Superior vena cava obstruction results from any limitation of blood flow through the superior vena cava. Circulation to the heart may persist through various collateral vessels whose development depends on the level of obstruction. Depending on the level and degree of occlusive disease, the severity of clinical symptoms may vary considerably, up to lethal. Etiologies have changed dramatically in recent years, mainly due to the increasing use of intravascular devices. However, guidelines for treatment are lacking, and various options are available. Endovascular therapies developed considerably in recent years, may offer a rapid improvement in symptoms and proved to be safe. However, knowledge and selection of appropriate techniques are essential to venous angioplasty, involving specific tools to guarantee satisfying outcomes. This review aims to discuss the particular venous anatomy of the upper body, the physiopathology of superior vena cava obstruction, and specificities of endovascular treatment compared with other management options.
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Affiliation(s)
- Alexandre Ponti
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - Sarah Saltiel
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - David C Rotzinger
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - Salah D Qanadli
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
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Azizi AH, Shafi I, Shah N, Rosenfield K, Schainfeld R, Sista A, Bashir R. Superior Vena Cava Syndrome. JACC Cardiovasc Interv 2021; 13:2896-2910. [PMID: 33357528 DOI: 10.1016/j.jcin.2020.08.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
Superior vena cava (SVC) syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC. The management of patients with life-threatening SVC syndrome is evolving from radiation therapy to endovascular therapy as the first-line treatment. There is a paucity of data and societal guidelines with regard to the management of SVC syndrome. This paper aims to update the practicing interventionalists with the contemporary and the evolving therapeutic approach to SVC syndrome. In addition, the review will focus on endovascular techniques, including catheter-directed thrombolysis, angioplasty, and stenting, and their associated complications.
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Affiliation(s)
- Abdul Hussain Azizi
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Irfan Shafi
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Neal Shah
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Kenneth Rosenfield
- Department of Cardiovascular Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Schainfeld
- Department of Cardiovascular Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Akhilesh Sista
- Department of Interventional Radiology, NYU Langone Health, New York, New York, USA
| | - Riyaz Bashir
- Department of Cardiovascular Diseases, Temple University Hospital, Philadelphia, Pennsylvania, USA.
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Azizi AH, Shafi I, Zhao M, Chatterjee S, Roth SC, Singh M, Lakhter V, Bashir R. Endovascular therapy for superior vena cava syndrome: A systematic review and meta-analysis. EClinicalMedicine 2021; 37:100970. [PMID: 34386747 PMCID: PMC8343254 DOI: 10.1016/j.eclinm.2021.100970] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Superior vena cava (SVC) syndrome is caused by the obstruction of the SVC and can result in significant morbidity and mortality. In contemporary practice, endovascular therapy (ET) has become the standard of care for a majority of these patients. This study is a systematic review and meta-analysis of the available literature to assess technical success, restenosis, and recurrence of SVC syndrome following endovascular intervention. METHODS For this meta-analysis, we conducted a systematic literature review of PubMed, Cochrane Library, and Embase databases from inception to April 14, 2021 for studies on ET for SVC syndrome. Studies included full-length journal articles on the use of ET among adults with SVC syndrome. Case reports or case series with fewer than 20 patients were excluded. We evaluated the endpoints of technical success rate, restenosis rate, and recurrence rates in SVC syndrome patients after endovascular stenting. The results of this study were calculated using random-effects models. FINDINGS We identified 6,012 reports, of which 39 studies met our inclusion criteria and were included for analysis. A total of 2200 patients received ET for SVC syndrome. The weighted technical success rate was 98.8% (95% CI 98.2-99.3) with low heterogeneity (I2=17.4%, p = 0.185), restenosis rate was 10.5% (95% CI 8.4-12.6) with moderate heterogeneity (I2=53.5%, p<0.001), and recurrence rate was 10.8% (95% CI 8.1-13.5) with high heterogeneity (I2=75.8%, p<0.001). Total complication rate was 8.6% (95% CI 7.3%-9.9%) with a mean complication rate of 7.5% (95% CI 4.7%-10.3%). INTERPRETATION Our systematic review revealed high technical success, low restenosis, and low recurrence rates following ET. Collectively, these results support the paradigm of ET as an effective and safe treatment for patients with SVC syndrome. FUNDING None.
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Affiliation(s)
- Abdul Hussain Azizi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Irfan Shafi
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, United States
| | - Matthew Zhao
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Saurav Chatterjee
- Division of Cardiology, Department of Medicine, Northshore-LIJ Hospitals of Northwell Health, and Assistant Professor of Medicine, Zucker School of Medicine, New York, NY, United States
| | - Stephanie Clare Roth
- Ginsburg Health Sciences Library, Temple University, Philadelphia, PA, United States
| | - Maninder Singh
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Vladimir Lakhter
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Riyaz Bashir
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
- Corresponding author.
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Percutaneous transluminal stenting for superior vena cava syndrome caused by malignant tumors: a single-center retrospective study. J Cardiothorac Surg 2021; 16:39. [PMID: 33743767 PMCID: PMC7981896 DOI: 10.1186/s13019-021-01418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate the efficacy of percutaneous stent placement in the treatment of superior vena cava syndrome caused by malignant tumors. Methods We retrospectively analyzed the clinical data of 32 patients with superior vena cava syndrome who underwent percutaneous endovascular stent treatment in our department from 2015 to 2019 due to malignant tumors and summarized the patient’s sex, age, tumor type, endovascular treatment plan, complications and postoperative follow-up. Results All patients successfully underwent percutaneous intraluminal stent placement with digital subtraction angiography (DSA). Thirty-seven endovascular stents were implanted in 32 patients, including 21 Eluminexx stents, 12 Wallstent stents and 4 covered stents. The technical success rate was 100%, and there were no serious surgery-related complications. The remission rate of clinical symptoms was 53.1% (17/32) at 24 h and 84.4% (27/32) at 48 h. After 48 h, the symptoms of the remaining patients were slowly relieved, and the symptom relief rate was 100% at 7 days. The follow-up period was 1.5–24 months, with an average follow-up period of 6.5 months. During the follow-up, 3 patients had restenosis and 1 patient had secondary thrombosis in the stent. Their symptoms were relieved after the second treatment. Conclusion For superior vena cava syndrome caused by malignant tumors, percutaneous endoluminal stent therapy can quickly and effectively relieve the clinical symptoms of patients, and the incidence of complications is low.
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Jalaie H, Gombert A, Grommes J, Schleimer K, Kurstjens RLM, de Graaf R, Wittens CHA, Razavi M, Barbati ME. Outcome of stenting in central venous obstruction of benign etiology. VASA 2020; 50:45-51. [PMID: 33112212 DOI: 10.1024/0301-1526/a000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The aim of this study is to evaluate long term outcome in patients treated for benign superior vena cava (SVC) syndrome by endovascular techniques. Patients and methods: Between 2015 and 2018, 62 patients suffering from central venous obstruction of benign etiology underwent balloon angioplasty with stent placement for venous obstruction in our department. Patency was assessed clinically, using duplex ultrasound in all patients or with CT-phlebography in selected cases. Results: Median age was 60 years (23-83), forty-one patients (66%) had central venous devices. Swelling of the arm and face were the main symptoms (71%). During the median follow up of 22 months (9-38), cumulative primary patency was 71% after venous stenting. The cumulative assisted primary and the secondary patency were 85% and 92%, respectively. Conclusions: Recanalization and stenting of central vein obstruction has turned out to be the technique of reference and provides satisfactory mid-term patency rates. After adjusting for the risk factors, presence of AV-fistula remained a significant risk factor for recurrent stenosis or loss of patency after intervention.
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Affiliation(s)
- Houman Jalaie
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Alexander Gombert
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Jochen Grommes
- Department of Vascular Surgery, Clinical Center of Rhein-Maas, Würselen, Germany
| | - Karina Schleimer
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Ralph L M Kurstjens
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rick de Graaf
- Department of Radiology and Interventional Radiology, Clinical Center of Friedrichshafen, Friedrichshafen, Germany
| | - Cees H A Wittens
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Klein-Weigel PF, Elitok S, Ruttloff A, Reinhold S, Nielitz J, Steindl J, Hillner B, Rehmenklau-Bremer L, Wrase C, Fuchs H, Herold T, Beyer L. Superior vena cava syndrome. VASA 2020; 49:437-448. [PMID: 33103626 DOI: 10.1024/0301-1526/a000908] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The superior vena cava syndrome (SVCS) is caused by compression, invasion, and/or thrombosis of the superior vena cava and/or the brachiocephalic veins. Benign SVCS is separated from malignant SVCS. SVCS comprises a broad clinical spectrum reaching from asymptomatic cases to rare life-threatening emergencies with upper airway obstruction and increased intracranial pressure. Symptoms are correlated to the acuity and extent of the venous obstruction and inversely correlated to the development of the venous collateral circuits. Imaging is necessary to determine the exact underlying cause and to guide further interventions. Interventional therapy has widely changed the therapeutic approach in symptomatic patients. This article provides an overview over this complex syndrome and focuses on interventional therapeutic methods and results.
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Affiliation(s)
- Peter Franz Klein-Weigel
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Saban Elitok
- Clinic for Nephrology, Endokrinology/Diabetology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Andreas Ruttloff
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Sabine Reinhold
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Jessika Nielitz
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Julia Steindl
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | | | | | - Christian Wrase
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Heiko Fuchs
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Thomas Herold
- Radiology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Lukas Beyer
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
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Li N, Zeng N, Chen B, Huang Y. Endovascular treatments of tunneled central venous catheter-induced superior vena cava complete occlusion via through-and-through technique. Hemodial Int 2020; 25:35-42. [PMID: 33040490 DOI: 10.1111/hdi.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Superior vena cava occlusion (SVCO) induced by tunneled central venous catheter (tCVC) is an uncommon but challenging complication of hemodialysis patients. The aim of this study was to access the efficacy, safety, and patency of stents in tCVC-related SVCO via through-and-through technique. METHOD We retrospectively identified seven patients with benign SVCO secondary to tCVC treated with endovascular approaches successfully between 1 March 2013 and 31 October 2019. Patients' demographic data, clinical signs and symptoms, and imaging data were followed up and recorded. RESULTS Technical success was achieved in all cases. All the patients were performed with percutaneous transcatheter angioplasty (PTA) and subsequently stent placement via the through-and-through technique. During follow-up, four patients underwent secondary interventions, including PTA and/or stent placement. The primary patency after 3, 6, 9 and 12 months was 100%, 100%, 86% and 86%, and secondary patency after 12 months was 100%. No procedure-related deaths occurred. CONCLUSIONS Endovascular management of SVCO is a safe and effective approach. CT examination can provide a direction for endovascular treatment and periodic surveillance.
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Affiliation(s)
- Nan Li
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ni Zeng
- Research Center of Medical Sciences, Guangdong General Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Bin Chen
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonghui Huang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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18
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Li N, Huang YH. Delayed pericardial tamponade following central venous recanalization. J Vasc Access 2020; 22:979-983. [PMID: 32611236 DOI: 10.1177/1129729820938177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A patient with central venous occlusion at the junction of the superior vena cava and right atrium underwent endovascular revascularization. The leakage of contrast agents was detected during sharp recanalization that was then managed with covered stent deployment. The initial symptom of facial swelling disappeared and the vital signs were stable after treatment. Regrettably, the patient suffered from the clinical features of cardiac tamponade on the third day post-treatment, which was confirmed by computed tomography. Finally, a pericardial effusion was drained, leading to dramatic improvement in the cardiovascular status of the patient.
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Affiliation(s)
- Nan Li
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong-Hui Huang
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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19
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Nowakowski P, Buszman P, Kiesz S, Buszman P. Iatrogenic occlusion of bilateral jugular veins, subclavian vein, and superior vena cava after repeated jugular cannulation associated with Arnold-Chiari malformation: Successful endovascular treatment. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:18-20. [PMID: 32051904 PMCID: PMC7005334 DOI: 10.1016/j.jvscit.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022]
Abstract
An Arnold-Chiari malformation is a congenital central nervous system defect. Raised intracranial pressure is commonly observed, and posterior decompression neurosurgery is the treatment of choice. We describe a patient with iatrogenic occlusion of bilateral jugular veins, subclavian vein, and superior vena cava resulting from repeated central venous cannulations. Because of venous hypertension, the patient suffered from neurologic symptoms: headaches, vision disturbances, and marked head edema. Two stents were used to recanalize the right internal jugular vein and superior vena cava. Symptoms subsided, and the patient returned to work. During 24-month follow-up, stents were patent. The patient remains symptom free and continues working.
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Affiliation(s)
- Przemyslaw Nowakowski
- Department of Vascular Surgery, American Heart of Poland, Chrzanow, Poland.,Andrzej Frycz-Modrzewski Krakow University, Krakow, Poland
| | - Piotr Buszman
- Katowice University of Technology, Katowice, Poland.,San Antonio Heart and Endovascular Institute, San Antonio, Tex
| | - Stefan Kiesz
- Center for Research and Development, American Heart of Poland, Katowice, Poland
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20
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Deshwal H, Ghosh S, Magruder K, Bartholomew JR, Montgomery J, Mehta AC. A review of endovascular stenting for superior vena cava syndrome in fibrosing mediastinitis. Vasc Med 2019; 25:174-183. [PMID: 31804157 DOI: 10.1177/1358863x19884130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Fibrosing mediastinitis (FM) is a rare disorder of inflammation and fibrosis involving the mediastinum. The formation of fibroinflammatory mass in the mediastinum can lead to obstruction of mediastinal structures and cause severe debilitating and life-threatening symptoms. Superior vena cava syndrome (SVCS) is a dreaded complication of FM with no medical therapy proven to be efficacious. Spiral vein grafting has long been utilized as first-line therapy for SVC syndrome due to FM. Endovascular repair with stents and angioplasty for malignant causes of SVC syndrome is well established. However, there are limited data on their utility in SVC syndrome due to FM. We present two cases of SVC syndrome due to FM treated with endovascular stenting and a detailed review of current literature on its utility in SVCS due to benign causes.
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Affiliation(s)
- Himanshu Deshwal
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, NY, USA
| | - Subha Ghosh
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Karen Magruder
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Abstract
Background The objective of management of superior vena cava syndrome (SVCS) is to promptly alleviate the uncomfortable symptoms. Conventional approaches do not always achieve results as rapidly as endovascular management with stent placement. Objectives To report the experience with endovascular management of SVCS of a Vascular and Endovascular Surgery Service at a Brazilian university hospital. Methods Symptomatic type III SVCS cases were managed with angioplasty and stent placement in 28 patients aged from 37 to 68 years, between 2002 and 2012. The etiology of SVCS was lung or thoracic cancer in 18 patients, while occlusion of the vein for prolonged use of catheters was the cause in the other 10 cases. Results Superior vena cava occlusion repair was not possible in one oligosymptomatic patient with a very severe lesion. Technical success was achieved in 96.4%. There were two deaths, one due to pulmonary embolism, 24 hours after a successful procedure, and the other due to compression of the airways by tumor mass some hours after the procedure. Clinical success was achieved in all cases of technical success, including one patient who died suddenly, after total regression of SVCS symptoms. Symptoms disappeared 24 hours and 48 hours after management in16 and 8 patients respectively; improvement was slower but progressive after 48 hours in the remaining patients. Conclusions Endovascular stent placement was effective for management of SVCS, with good technical and clinical success rates and provided prompt relief from symptoms.
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Affiliation(s)
- Walter Kegham Karakhanian
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | - Walter Zavem Karakhanian
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | - Sergio Quilici Belczak
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
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Riahi M, Velasco Forte MN, Byrne N, Hermuzi A, Jones M, Baruteau AE, Valverde I, Qureshi SA, Rosenthal E. Early experience of transcatheter correction of superior sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage. EUROINTERVENTION 2019; 14:868-876. [PMID: 30012542 DOI: 10.4244/eij-d-18-00304] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Superior sinus venosus atrial septal defect (SVASD) is commonly associated with partial anomalous pulmonary venous drainage (PAPVD). We aimed to describe the first series of percutaneous SVASD and PAPVD correction using a two-step simulation for procedural planning. METHODS AND RESULTS Patients with SVASD and right PAPVD with a clinical indication for correction were selected. They underwent an ex vivo procedural simulation on a 3D-printed model followed by an in vivo simulation using balloon inflation in the targeted stent landing zone. The percutaneous procedure consisted in deploying a 10-zig custom-made covered stent in the SVC-RA junction. Five patients were referred for preprocedural evaluation and were deemed suitable for percutaneous correction. The procedure was successful in all patients with no residual interatrial shunt and successful redirection of the pulmonary venous drainage to the left atrium. At a median clinical follow-up of 8.1 months (2.6-19.8), no adverse events were noted, and all patients showed clinical improvement. During follow-up, transthoracic echocardiography and multidetector cardiac tomography in four patients or invasive angiography in one patient demonstrated a patent SVC stent, and no residual SVASD and unobstructed PV drainage in all patients. CONCLUSIONS In selected patients using a two-stage simulation strategy, percutaneous correction of SVASD with PAPVD is feasible and safe, and led to favourable short-term outcomes.
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Affiliation(s)
- Mounir Riahi
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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23
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Colombier S, Girod G, Niclauss L, Danzer D, Eeckhout E, Qanadli SD, Delay D. Total Endovascular Repair of Post-Trauma Ascending Aortic Pseudoaneurysm and Secondary Superior Vena Cava Syndrome. Ann Vasc Surg 2019; 61:468.e13-468.e17. [PMID: 31376549 DOI: 10.1016/j.avsg.2019.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/28/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Clavicular fracture or sternoclavicular luxation is observed in 10% of all polytrauma patients and is frequently associated with concomitant intrathoracic life-threatening injuries. Posterior sternoclavicular luxation is well known to induce underlying great vessels damage. The gold standard treatment usually is a combined orthopedic and cardiovascular surgical procedure associating vascular repair, clavicular open reduction, and internal fixation. METHODS A 59-year-old wheelchair ridden, institutionalized woman, known for psychiatric disorder, severe scoliosis, malnutrition, and chronic obstructive pulmonary disease was admitted in our hospital for chronic chest pain 3 months after a stairway wheelchair downfall. A thoracic computed tomography (CT) scan revealed a voluminous ascending aortic pseudoaneurysm (63 × 58 mm, orifice 5 mm) consecutive to perforation following posterior sternoclavicular luxation. The patient refused all therapies and was lost to follow-up. Six months later, she was readmitted for a symptomatic superior vena cava syndrome. Thoracic CT scan revealed pseudoaneurysm growth with innominate vein thrombosis and superior vena cava subocclusion. Pseudoaneurysm orifice was stable. In the presence of symptoms with massive facial edema and inability to open her eyelids, the patient accepted an endovascular treatment. RESULTS The procedure was performed under general anesthesia using both fluoroscopic and transesophageal echocardiographic guidance. Through a femoral arterial access, a 10-mm atrial septal defect occluder device was used to seal successfully the pseudoaneurysm orifice. The superior vena cava was then opened with a 26-mm nitinol high radial force stent through a femoral venous access. Postoperative course was uneventful. At 3-month follow-up, the patient remains symptom free and a CT scan confirmed pseudoaneurysm thrombosis and superior vena cava permeability. CONCLUSION Post-traumatic sternoclavicular posterior luxation is a cause of great vessels and ascending aorta injuries. Minimally invasive endovascular approaches can be considered to treat vascular injuries and their consequences, especially in elderly patients and those at high risk for surgery.
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Affiliation(s)
- Sébastien Colombier
- Department of Cardiac Surgery, Hôpital du Valais, Sion, Switzerland; Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Grégoire Girod
- Department of Cardiology, Hôpital du Valais, Sion, Switzerland
| | - Lars Niclauss
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Daniel Danzer
- Department of Vascular Surgery, Hôpital du Valais, Sion, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Salah Dine Qanadli
- Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Dominique Delay
- Department of Cardiac Surgery, Hôpital du Valais, Sion, Switzerland
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Baskin KM, Mermel LA, Saad TF, Journeycake JM, Schaefer CM, Modi BP, Vrazas JI, Gore B, Drews BB, Doellman D, Kocoshis SA, Abu-Elmagd KM, Towbin RB. Evidence-Based Strategies and Recommendations for Preservation of Central Venous Access in Children. JPEN J Parenter Enteral Nutr 2019; 43:591-614. [PMID: 31006886 DOI: 10.1002/jpen.1591] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
Abstract
Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter-related complications (high-risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life-preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high-need, high-cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state-of-the-art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient-centered, multidisciplinary, collaborative, and evidence-based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.
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Affiliation(s)
- Kevin M Baskin
- VANGUARD, Venous Access (VANGUARD) Task Force, Society of Interventional Radiology (SIR), Pittsburgh, Pennsylvania, USA
| | - Leonard A Mermel
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | - Janna M Journeycake
- Jimmy Everest Center for Cancer and Blood Disorders in Children, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Carrie M Schaefer
- Pediatric Interventional Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Biren P Modi
- Center for Advanced Intestinal Rehabilitation, Children's Hospital of Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - John I Vrazas
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Beth Gore
- Association for Vascular Access, Herriman, Utah, USA
| | | | - Darcy Doellman
- Vascular Access Team, Children's Hospital of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Samuel A Kocoshis
- Pediatric Nutrition and Intestinal Care Center, Children's Hospital of Cincinnati Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kareem M Abu-Elmagd
- Cleveland Clinics Foundation Hospitals and Clinics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard B Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA
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- VANGUARD, Venous Access (VANGUARD) Task Force, Society of Interventional Radiology (SIR), Pittsburgh, Pennsylvania, USA
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Tan GM, Chi KWK, Yan BPY. Mid-term Results of a Novel Dedicated Venous Stent for the Treatment of Chronic Thoracic Central Vein Obstruction of Benign Aetiology. Eur J Vasc Endovasc Surg 2018; 57:417-423. [PMID: 30404722 DOI: 10.1016/j.ejvs.2018.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/06/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Endovascular treatment is indicated for the treatment of symptomatic thoracic central vein obstruction (TCVO) but is limited by high rates of restenosis and the need for re-intervention. The aim was to assess the safety and mid-term patency of a novel dedicated venous stent for the treatment of TCVO of benign aetiology. METHODS This was a prospective single centre observational study of 20 patients (median age 65 years, 50% male) referred for the treatment of symptomatic chronic (>three months duration) TCVO between May 2016 and January 2018. Balloon angioplasty with implantation of a self expanding nitinol stent (Vici, Boston Scientific, Marlborough, MA, USA) was performed in all patients. Clinical records including demographics, aetiologies and types of TCVO, and procedural details were recorded. Patients were followed up clinically at one, six, and 12 months. Primary and assisted primary patency were reported. RESULTS All 20 lesions were total occlusions, of which 55% (n = 11) were de novo, 10% (n = 2) peri-stent restenosis, and 35% (n = 7) in-stent re-occlusion. The aetiology of TCVO was predominantly (95%) because of multiple or prolonged central venous line insertion. The procedural success rate was 90% (18/20) with no procedural complications. The median follow up was 13.5 months. Primary patency was 100% at 6 months. One patient required re-intervention for stent in segment restenosis at 7 months. The assisted primary patency rate was 100% at 12 months. CONCLUSION Endovascular treatment of benign TCVO with the novel dedicated venous stent was safe and effective in relieving obstructive symptoms with excellent one year patency rates.
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Affiliation(s)
- Guang Ming Tan
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ken Wai Kin Chi
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Bryan Ping Yen Yan
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia.
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Is Long-Term Anticoagulation Required after Stent Placement for Benign Superior Vena Cava Syndrome? J Vasc Interv Radiol 2018; 29:1741-1747. [PMID: 30396845 DOI: 10.1016/j.jvir.2018.07.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/15/2018] [Accepted: 07/23/2018] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To identify whether symptom relief and stent patency vary with use of long-term anticoagulation after stent placement for benign superior vena cava (SVC) syndrome. MATERIALS AND METHODS Patients with benign SVC syndrome treated with stent placement between January 1999 and July 2017 were retrospectively identified (n = 58). Average age was 49 years (range, 24-80 y); 34 (58%) were women, and 24 (42%) were men. Average follow-up was 2.4 years (range, 0.1-11.1 y, SD 2.6). Of cases, 37 (64%) were due to a long-term line/pacemaker, and 21 (36%) were due to fibrosing mediastinitis. After stent placement, 36 (62%) patients were placed on long-term anticoagulation, and 22 (38%) were not placed on anticoagulation. Percent stenosis was evaluated on follow-up imaging by dividing smallest diameter of the stent by a normal nonstenotic segment of the stent and multiplying by 100. RESULTS Technical success was achieved in all cases. There was no significant difference in number of patients who reported a return of symptoms characteristic of benign SVC syndrome between the anticoagulated (16 of 36; 44.4%) and nonanticoagulated (11 of 22; 50%) groups (P = .68). There was no significant difference in the mean percent stenosis between the anticoagulated (40.4% ± 34.7% [range, 0-100%]) and nonanticoagulated (32.1% ± 29.2% [range, 1.7%-100%]) groups (P = .36). No significant difference was found in the time (days) between date of procedure and date of return of symptoms (anticoagulated, 735.9 d ± 1,003.1 [range, 23-3,851 d]; nonanticoagulated, 478 d ± 826.6 [range, 28-2,922 d]) (P = .49). There was no difference in primary patency between groups (P = .59). Finally, 1 patient (2.8%) in the anticoagulated group required surgical intervention, whereas none in the nonanticoagulated group required surgical intervention. CONCLUSIONS No significant difference was observed in clinical and treatment outcomes in patients who did and did not receive anticoagulation after stent placement for benign SVC syndrome. Management of benign SVC syndrome after stent placement may not require anticoagulation if confirmed by additional studies.
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Sotiriadis C, Volpi S, Douek P, Chouiter A, Muller O, Qanadli SD. Are Endovascular Interventions for Central Vein Obstructions due to Cardiac Implanted Electronic Devices Effective? Front Surg 2018; 5:49. [PMID: 30105227 PMCID: PMC6077194 DOI: 10.3389/fsurg.2018.00049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: One of the late-onset complications of cardiac implanted electronic devices (CIEDs) is central venous obstruction (CVO). The aim of this study was to investigate the feasibility, efficacy, and safety of endovascular treatment of CIED-related CVOs. Methods:Eighteen patients who underwent endovascular management of their device-related CVO were reviewed. Patients were classified into three groups: Group I patients were asymptomatic and needed lead replacement; Group II patients presented with symptomatic CVO without lead dysfunction, and Group III patients were referred with both symptomatic CVO and lead dysfunction. A treatment strategy involved recanalization and balloon angioplasty for Group I and angioplasty/stents for Groups II and III. Technical success, clinical success, complications, and long-term follow-up were assessed. Results: Thirteen patients were in Group I, four in Group II, and one in Group III. Technical and clinical success was achieved in 17 patients (94%). No major complications were reported. Restenosis was observed in two patients at 40 and 42 weeks of follow-up, and these patients were successfully treated with angioplasty. Conclusion: Endovascular management of CVO due to CIED is a safe and efficient technique. Plain balloon angioplasty is sufficient for lead replacement purposes, while stenting is needed for symptomatic CVO to achieve good long-term patency.
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Affiliation(s)
- Charalampos Sotiriadis
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Stephanie Volpi
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Pauline Douek
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Amine Chouiter
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Salah D Qanadli
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
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Quilotórax recidivante por obstrucción de la vena cava secundaria superior. Arch Bronconeumol 2018; 54:434-435. [DOI: 10.1016/j.arbres.2017.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 11/18/2022]
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Abstract
Superior vena cava syndrome occurs from obstruction of the superior vena cava. The most common cause is malignancy. Small cell lung cancer and non-Hodgkin lymphoma are the most frequent culprits. Intravascular devices associated with thrombus are becoming more common causes. Classic symptoms include edema, plethora, and distended veins of the face, neck, and chest; shortness of breath; cough; headache; and hoarseness. Treatment in the emergency department is mostly supportive, with head elevation, oxygen, and steroids. Rarely, emergent airway issues and cerebral edema must be addressed. Definitive treatment includes radiotherapy, chemotherapy, and stenting.
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Affiliation(s)
- Shelly Zimmerman
- Emergency Medicine Residency, Norman Regional Health Systems, GME Office, 901 North Porter, Norman, OK 73071, USA; Department of Family Medicine, Oklahoma State University College of Osteopathic Medicine, 1111 West 17th Street, # A247, Tulsa, OK 74107, USA.
| | - Matthew Davis
- Emergency Medicine Residency, Norman Regional Health Systems, GME Office, 901 North Porter, Norman, OK 73071, USA
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Bardet J, Fabre D, Brenot P, Watkins C, Fadel E. Kissing Stents for Superior Vena Cava Syndrome Due to Mediastinal Fibrosis. Open J Cardiovasc Surg 2018; 10:1179065218771900. [PMID: 29872339 PMCID: PMC5977417 DOI: 10.1177/1179065218771900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/28/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose: To report the endovascular reconstruction of the superior vena cava (SVC), innominate and internal jugular veins following stenosis due to mediastinal fibrosis. Case Report: A 36-year-old female with mediastinal fibrosis was referred for symptomatic SVC syndrome (SVCS). A covered stent was inserted in the SVC with 2 kissing stents in the innominate and jugular veins via anterograde right femoral vein access with sandwich technique. She exhibited near-immediate relief of debilitating symptoms. Computed tomographic scan demonstrated patent vessels at 1 year. Conclusions: Extensive endovascular venous reconstruction is an effective treatment for SVCS due to mediastinal fibrosis.
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Affiliation(s)
- Jérémy Bardet
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France
| | - Philippe Brenot
- Department of Radiology, Marie-Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France
| | - Claire Watkins
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France
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Haddad MM, Simmons B, McPhail IR, Kalra M, Neisen MJ, Johnson MP, Stockland AH, Andrews JC, Misra S, Bjarnason H. Comparison of Covered Versus Uncovered Stents for Benign Superior Vena Cava (SVC) Obstruction. Cardiovasc Intervent Radiol 2018; 41:712-717. [PMID: 29492630 DOI: 10.1007/s00270-018-1906-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/17/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify whether long-term symptom relief and stent patency vary with the use of covered versus uncovered stents for the treatment of benign SVC obstruction. METHODS AND MATERIALS We retrospectively identified all patients with benign SVC syndrome treated to stent placement between January 2003 and December 2015 (n = 59). Only cases with both clinical and imaging follow-up were included (n = 47). In 33 (70%) of the patients, the obstruction was due to a central line or pacemaker wires, and in 14 (30%), the cause was fibrosing mediastinitis. Covered stents were placed in 17 (36%) of the patients, and 30 (64%) patients had an uncovered stent. Clinical and treatment outcomes, complications, and the percent stenosis of each stent were evaluated. RESULTS Technical success was achieved in all cases at first attempt. Average clinical and imaging follow-up in years was 2.7 (range 0.1-11.1) (covered) and 1.7 (range 0.2-10.5) (uncovered), respectively. There was a significant difference (p = 0.044) in the number of patients who reported a return of symptoms between the covered (5/17 or 29.4%) and uncovered (18/30 or 60%) groups. There was also a significant difference (p = < 0.001) in the mean percent stenosis after stent placement between the covered [17.9% (range 0-100) ± 26.2] and uncovered [48.3% (range 6.8-100) ± 33.5] groups. No significant difference (p = 0.227) was found in the time (days) between the date of the procedure and the date of clinical follow-up where a return of symptoms was reported [covered: 426.6 (range 28-1554) ± 633.9 and uncovered 778.1 (range 23-3851) ± 1066.8]. One patient in the uncovered group had non-endovascular surgical intervention (innominate to right atrial bypass), while none in the covered group required surgical intervention. One major complication (SIR grade C) occurred that consisted of a pericardial hemorrhagic effusion after angioplasty that required covered stent placement. There were no procedure-related deaths. CONCLUSION Both covered and uncovered stents can be used for treating benign SVC syndrome. Covered stents, however, may be a more effective option at providing symptom relief and maintaining stent patency if validated by further studies.
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Affiliation(s)
- Mustafa M Haddad
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA.
| | - Benjamin Simmons
- Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Ian R McPhail
- Departments of Cardiology and Vascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Manju Kalra
- Department of Vascular Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Melissa J Neisen
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Matthew P Johnson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Andrew H Stockland
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - James C Andrews
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Sanjay Misra
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Haraldur Bjarnason
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
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Volpi S, Doenz F, Qanadli SD. Superior Vena Cava (SVC) Endovascular Reconstruction with Implanted Central Venous Catheter Repositioning for Treatment of Malignant SVC Obstruction. Front Surg 2018; 5:4. [PMID: 29435452 PMCID: PMC5790922 DOI: 10.3389/fsurg.2018.00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/09/2018] [Indexed: 11/24/2022] Open
Abstract
Superior vena cava (SVC) syndrome is a group of clinical signs caused by the obstruction or compression of SVC and characterized by edema of the head, neck, and upper extremities, shortness of breath, and headaches. The syndrome may be caused by benign causes but most of the cases are caused by lung or mediastinal malignant tumors. Stenting of SVC has become widely accepted as the palliative treatment for this condition in malignant diseases, as it offers rapid relief of symptoms and improves the quality of life. Preserving previously placed central venous catheters (CVCs) is a major issue in this population. We report the case of a patient with SVC syndrome caused by tumoral obstruction due to central small-cell lung cancer who had right subclavian implanted CVC and a preferential head and neck venous drainage through the left internal jugular and brachiocephalic vein (BCV). We describe a complex procedure of SVC reconstruction with two different objectives: left recanalization and stent placement to ensure head and neck venous drainage and right BCV stenting for CVC repositioning and subsequent replacement. We also review published cases of SVC obstructions stenting with catheter repositioning. The patient experienced quick relief of symptoms after treatment. Chemotherapy was rapidly delivered through the preserved implanted CVC access. A 3-month follow-up computed tomography showed stents patency.
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Affiliation(s)
- Stephanie Volpi
- Cardio-Thoracic and Vascular Unit, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Francesco Doenz
- Cardio-Thoracic and Vascular Unit, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Salah D Qanadli
- Cardio-Thoracic and Vascular Unit, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Anton S, Oechtering T, Stahlberg E, Jacob F, Kleemann M, Barkhausen J, Goltz JP. Endovascular stent-based revascularization of malignant superior vena cava syndrome with concomitant implantation of a port device using a dual venous approach. Support Care Cancer 2017; 26:1881-1888. [PMID: 29274029 DOI: 10.1007/s00520-017-3997-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this paper is to evaluate the safety and efficacy of endovascular revascularization of malignant superior vena cava syndrome (SVCS) and simultaneous implantation of a totally implantable venous access port (TIVAP) using a dual venous approach. MATERIALS AND METHODS Retrospectively, 31 patients (mean age 67 ± 8 years) with malignant CVO who had undergone revascularization by implantation of a self-expanding stent into the superior vena cava (SVC) (Sinus XL®, OptiMed, Germany; n = 11 [Group1] and Protégé ™ EverFlex, Covidien, Ireland; n = 20 [Group 2]) via a transfemoral access were identified. Simultaneously, percutaneous access via a subclavian vein was used to (a) probe the lesion from above, (b) facilitate a through-and-through maneuver, and (c) implant a TIVAP. Primary endpoints with regard to the SVC syndrome were technical (residual stenosis < 30%) and clinical (relief of symptoms) success; with regard to TIVAP implantation technical success was defined as positioning of the functional catheter within the SVC. Secondary endpoints were complications as well as stent and TIVAP patency. RESULTS Technical and clinical success rate were 100% for revascularization of the SVS and 100% for implantation of the TIVAP. One access site hematoma (minor complication, day 2) and one port-catheter-associated sepsis (major complication, day 18) were identified. Mean catheter days were 313 ± 370 days. Mean imaging follow-up was 184 ± 172 days. Estimated patency rates at 3, 6, and 12 months were 100% in Group 1 and 84, 84, and 56% in Group 2 (p = 0.338). CONCLUSION Stent-based revascularization of malignant SVCS with concomitant implantation of a port device using a dual venous approach appears to be safe and effective.
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Affiliation(s)
- Susanne Anton
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - T Oechtering
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - E Stahlberg
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - F Jacob
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - M Kleemann
- Clinic for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - J Barkhausen
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - J P Goltz
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Lai CH, Chang WC, Liu TJ, Lee WL, Su CS. Endovascular Treatment of Concomitant Obstructions of a Denver Drainage Catheter and Superior Vena Cava in a Patient With Liver Cirrhosis. Int Heart J 2017; 58:447-450. [PMID: 28484121 DOI: 10.1536/ihj.16-300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With the increased use of intravascular catheters and devices, they have become the major non-malignant cause of superior vein cava (SVC) syndrome. We report a patient with liver cirrhosis who had received a peritoneovenous drainage catheter for refractory ascites, and then developed SVC syndrome because of concomitant occlusions of both the SVC and the drainage catheter. The patient regained patency of both the occluded vessel and the drainage catheter through percutaneous transluminal venoplasty, and there was dramatic improvement of clinical symptoms and good performance of the drainage catheter. Percutaneous intervention may be a feasible and effective therapy for SVC syndrome and intra-catheter thrombosis-related dysfunction.
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Affiliation(s)
- Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
| | - Wei-Chun Chang
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
| | - Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
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Clark K, Chick JFB, Reddy SN, Shin BJ, Nadolski GJ, Clark TW, Trerotola SO. Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction. J Vasc Interv Radiol 2017; 28:602-607. [PMID: 28238580 DOI: 10.1016/j.jvir.2016.12.1222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction. MATERIALS AND METHODS CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance. RESULTS All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days). CONCLUSIONS Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.
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Affiliation(s)
- Katherine Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Shilpa N Reddy
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Radiology Associates of the Main Line, Main Line Health System, Bryn Mawr Hospital, Bryn Mawr, Pennsylvania
| | - Benjamin J Shin
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Timothy W Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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Abstract
Central venous stenosis or occlusion is a common and vexing problem in patients undergoing hemodialysis. Typical presenting symptoms include arm swelling and prolonged bleeding after hemodialysis. Despite multiple treatment approaches, these stenoses tend to recur and progress over time. A thorough preprocedure evaluation, methodical procedural approach and awareness of potential complications are all essential to try to preserve vascular access and improve patients' quality of life.
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Affiliation(s)
- Masahiro Horikawa
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR
| | - Keith B Quencer
- Division of Interventional Radiology, Department of Radiology, University of California, San Diego, San Diego, CA; Dotter Interventional Institute, Oregon Health and Science University, Portland, OR.
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