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Superior Vena Cava Syndrome as Sequelae of Novel Hodgkin Lymphoma. Am J Med 2022; 135:e123-e124. [PMID: 35202569 DOI: 10.1016/j.amjmed.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/21/2022]
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Ma M, Zhang J, Hou J, Gong Z, Hu Z, Chen S, Kong X, Shi Z. The application of intracavitary electrocardiogram for tip location of femoral vein catheters in chemotherapy patients with superior vena cava obstruction. J Vasc Access 2020; 22:613-622. [PMID: 32928030 DOI: 10.1177/1129729820958334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Most studies focused on the application of intracavitary electrocardiogram (IC-ECG) location in superior vena cava access catheterization, this study aimed to explore the effect of IC-ECG for tip location of femoral vein catheters in chemotherapy patients with superior vena cava obstruction (SVCO). METHODS A total of 158 patients placed catheters through superficial femoral vein from July 2016 to May 2019 were enrolled in the randomized controlled study. The patients were divided into two groups by envelope lottery method: X-ray location was used in the control group (n = 79); IC-ECG location was used in the observation group (n = 79). The catheters should be located at or near the inferior vena cava (IVC)-right atrium (RA) junction (above the level of diaphragm within the IVC). The general information of patients, clinical catheterization effects and catheter-related complications were compared between the groups. RESULTS No significant differences in general information, catheter obstruction, catheter-related thrombosis, catheter exit-site bleeding and infection were found between the groups. The rate of successful insertion at the first attempt and patient satisfaction in the observation group were significantly higher than that in the control group (p < 0.05). The time and cost of location and the incidence of catheter-related complications in the control group were 32.57 min and 140.51 Yuan and 21.5%, which were significantly higher than 6.94 min and 13.59 Yuan and 7.6% in the observation group (p < 0.05). CONCLUSION IC-ECG accurately located the tip of femoral vein catheters, reduced the incidence of catheter-related complications and the time and cost of location, improved patient satisfaction.
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Affiliation(s)
- Mengdan Ma
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jianmei Hou
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhihong Gong
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zixin Hu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shujie Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoya Kong
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhengkun Shi
- Department of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Bassiouni M, Olze H, Dommerich S. Superior Vena Cava Syndrome With Laryngeal Edema Mimicking Drug-Induced Angioedema: Implications for Otolaryngology. EAR, NOSE & THROAT JOURNAL 2020; 100:NP379-NP380. [PMID: 32293907 DOI: 10.1177/0145561320920745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mohamed Bassiouni
- Department of Otorhinolaryngology, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steffen Dommerich
- Department of Otorhinolaryngology, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Computed Tomography Findings Associated With 30-Day Mortality in Patients With Malignant Superior Vena Cava Syndrome. J Comput Assist Tomogr 2019; 43:912-918. [PMID: 31738208 DOI: 10.1097/rct.0000000000000934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to identify radiological and clinical factors associated with early mortality in malignant superior vena cava syndrome (SVCS). MATERIALS AND METHODS Chest computed tomography studies of 127 patients with malignancy-associated SVCS were retrospectively reviewed. Involvement of SVC and tributaries, pleural and pericardial effusions, pulmonary artery involvement, and ancillary findings were documented. Univariate and multivariate models determined associations between radiological and clinical variables, and 30-day mortality. RESULTS Thirty-day mortality rate was 16.5% (n = 21). Factors associated with 30-day mortality on univariate analysis included age, cancer stage, SVCS clinical severity, left jugular vein obstruction, number of involved veins, pulmonary arteries involvement, and presence of pleural effusions. Age, SVCS clinical severity, number of veins involved, and pleural effusions were positively associated with 30-day mortality on multivariate analysis. CONCLUSIONS Selected clinical and radiological variables are associated with early death in malignant SVCS. These factors may identify a subgroup of patients who may benefit from treatment escalation.
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Hou J, Zhang J, Ma M, Gong Z, Xu B, Shi Z. Thrombotic risk factors in patients with superior vena cava syndrome undergoing chemotherapy via femoral inserted central catheter. Thromb Res 2019; 184:38-43. [PMID: 31706066 DOI: 10.1016/j.thromres.2019.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/14/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Our study aimed to scrutinize the incidence and risk factors of femoral inserted central catheter (FICC)-related thrombosis in patients with superior vena cava syndrome (SVCS) undergoing chemotherapy. METHODS A retrospective analysis of patients with SVCS undergoing chemotherapy who received FICC catheterization at the Xiangya Hospital, Central South University, Changsha City, Hunan Province between May 2012 and February 2019 was performed. Both asymptomatic thrombosis and symptomatic thrombosis were diagnosed by color doppler ultrasound (CDUS). Univariate and multivariate logistic regression analyses were performed to identify patient-, insertion-, and catheter-related factors. RESULTS Eight hundred and seventy-four patients with SVCS undergoing chemotherapy, with a total of 157,180 catheter days were enrolled in our study. FICC-related thrombosis was detected in 144 patients, and yielding an overall incidence of 16.47% or 0.92 events per 1000 catheter days. Of these, 19(2.17%) patients had symptomatic thrombosis. The mean time interval between FICC insertion and thrombosis onset was (10.40 ± 6.32) days and the mean catheter indwelling time was (179.84 ± 46.15) days. The history of deep venous thrombosis, treatment with vascular endothelial growth factor (VEGF) inhibitor (bevacizumab), puncture site (mid-thigh, groin), tip position and catheter size showed association with FICC-related thrombosis. Treatment with VEGF inhibitor [odds ratio (OR) = 2.779; 95%confidence interval (CI): 1.860-4.153; P < 0.001] and puncture site at the groin (OR = 10.843; 95%CI: 6.575-17.881; P < 0.001) were identified as independent risk factors of FICC-related thrombosis. CONCLUSION Treatment with VEGF inhibitor and puncture site at the groin during FICC catheterization were considered as high-risk factors in FICC-related thrombosis.
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Affiliation(s)
- Jianmei Hou
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China; Xiang Ya Nursing School of Central South University, Changsha 410013, China
| | - Jinghui Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Mengdan Ma
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China; Xiang Ya Nursing School of Central South University, Changsha 410013, China
| | - Zhihong Gong
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China; Xiang Ya Nursing School of Central South University, Changsha 410013, China
| | - Binbin Xu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China; Xiang Ya Nursing School of Central South University, Changsha 410013, China
| | - Zhengkun Shi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
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The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome. J Vasc Access 2018; 19:34-39. [PMID: 29148000 DOI: 10.5301/jva.5000810] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: To investigate the feasibility and safety of the peripherally inserted central catheters (PICCs) accessed via the superficial femoral vein in patients with superior vena cava syndrome (SVCS). Methods: From October 2010 to December 2014, 221 cancer patients with SVCS in our center received real-time ultrasound-guidance of the superficial femoral vein inserted central catheters (FICCs) at the mid-thigh. PICC insertion via upper extremity veins had also been investigated in 2604 cancer patients without SVCS as control. The average catheterization time, one-time puncture frequency, catheter duration and complications were compared between two groups. Results: In the FICC group, the mean catheterization time was 31.60 ± 0.15 minutes, one-time puncture frequency was 1.05 ± 0.08, and catheter duration was 168.95 ± 20.47 days. There was no significant difference compared with the upper extremity veins PICC group: 31.11 ± 3.86 minutes, 1.03 ± 0.30, and 173.58 ± 39.81 days, respectively. The major complications included skin allergy to chlorhexidine gluconate (CHG) dressings, exudation, catheter-related infection, catheter occlusions, unplanned catheter withdrawal, venous thrombosis, mechanical phlebitis, and catheter malposition. It is interesting that a higher rate of catheter malposition was observed in the upper extremity veins PICC group than in the FICC group (2.15% vs. 0.00%). There were no significant differences in other complications between the two groups. Conclusions: Real-time ultrasound-guided PICCs accessed via the superficial femoral vein at the mid-thigh is a new modified technique with low complications, which can be a feasible and safe alternative venous access for patients with SVCS.
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Calsina Juscafresa L, Gil Bazo I, Grochowicz L, Páramo Alfaro M, López-Picazo González JM, Moreno Jiménez M, Bilbao Jaureguizar JI. Endovascular treatment of malignant superior vena cava syndrome secondary to lung cancer. Hosp Pract (1995) 2017; 45:70-75. [PMID: 28618844 DOI: 10.1080/21548331.2017.1342507] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Superior Vena Cava obstruction results in severe oedema of the upper thorax. Endovascular treatment allows a rapid restoration of the blood flow with a rapid resolution of symptoms. We retrospectively report a single institution's experience in stent placement for malignant Superior Vena Cava Syndrome (SVCS) caused by lung cancer. METHODS Thirty-three consecutive patients (23 men, 10 women; median age, 57.6 years; range 34-71 years) who underwent endovascular SVCS palliative treatment were enrolled between August 2002 and June 2015. All patients presented SVCS secondary to lung cancer. Signs and symptoms of SVCS were scored. RESULTS All procedures were successfully completed (100% technical success rate). Twenty-eight patients showed a progressive clinical improvement after endovascular treatment of SVCS (84.8% clinical success rate) within 48 hours, there were five clinical failures which improved progressively with posterior radiotherapy. During follow-up, three patients (9%) suffered intra or post-procedural complications (1 cardiac arrhythmia, 2 stent thrombosis). CONCLUSIONS Stent placement in malignant SVCS seems to be an effective and rapid treatment for the relief of symptoms and quality of life improvement with a relatively low complications rate with a rapid resolution of symptoms. Therefore, it should be seriously considered as the first option in the SVC obstruction treatment.
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Affiliation(s)
| | | | - Lukasz Grochowicz
- a Vascular Surgery , Clínica Universidad de Navarra , Pamplona , Spain
| | - María Páramo Alfaro
- c Interventional Radiology , Clínica Universidad de Navarra , Pamplona , Spain
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Femorally inserted central venous catheter in patients with superior vena cava obstruction: choice of the optimal exit site. J Vasc Access 2016; 18:82-88. [PMID: 27791258 DOI: 10.5301/jva.5000592] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study assessed patient comfort and catheter indwelling time and decreased incidence of complications in patients with femorally inserted venous catheters (FIVCs) via different exit sites. METHODS A group of 114 patients suffering from lung cancer complicated by superior vena cava obstruction (SVCO) underwent femoral insertion of venous catheters to facilitate chemotherapy infusion. Patients were divided into two groups: a novel (NOV) group (n = 59) with the FIVC exit site at the mid-thigh and a conventional (CON) group (n = 55) with the exit site at the groin. The clinical efficacy and safety were compared. RESULTS There were significant differences (p<0.001) between NOV and CON groups in bleeding scores (2.44 ± 0.62 vs. 1.36 ± 0.49), catheter indwelling time (195.08 ± 39.19 days vs. 91.53 ± 32.88 days), patient comfort scores (4.20 ± 0.87 vs. 1.35 ± 0.91), and pain scores (1.64 ± 0.91 vs. 2.42 ± 1.08). Significant differences (p<0.05) were also observed in catheter-associated thrombosis (1.69% vs. 14.55%), catheter exit site infection (1.69% vs. 21.82%), and the incidence of total complications (11.86% vs. 45.45%) between the NOV and CON groups. However, the differences in success rates between the NOV and CON groups during the first attempt (98.32% vs. 98.18%) and catheter obstruction (8.48% vs. 9.09%) were not significant (p>0.05). CONCLUSIONS Compared with the conventional exit site at the groin, the exit site at the mid-thigh for FIVCs increased patients' comfort and catheter indwelling time, and decreased the rate of complication and pain scores. However, it did not decrease the success rate in SVCO patients.
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Ozpinar A, Liu JJ, Tempel ZJ, Choi PA, Hart RA, Hamilton DK. Intracranial pressure monitoring during adult spinal deformity correction in a patient with critical venous occlusive disease and superior vena cava syndrome: A technical note. Surg Neurol Int 2016; 7:47. [PMID: 27168950 PMCID: PMC4854031 DOI: 10.4103/2152-7806.180771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/11/2016] [Indexed: 12/03/2022] Open
Abstract
Background: Intracranial pressure (ICP) monitoring is not routinely used during complex spinal deformity correction surgery. The authors report a 66-year-old male who during thoracolumbar deformity surgery required the placement of an ICP monitor due to the underlying history of a superior vena cava syndrome (e.g., s/p right jugular stent). Case Description: A 66-year-old male with multiple prior lumbar spinal procedures presented with lower back and bilateral lower extremity pain, paresthesias, and weakness. He had a history of chronic left internal jugular and brachiocephalic venous occlusion (e.g., he had a right internal jugular stent). During deformity surgery, a frontal intraparenchymal ICP monitor was placed. During the early portion of the operation, bed adjustments (increasing reverse trendelenburg position) were required to compensate for ICP elevations as high as 30 mm Hg. A subsequent inadvertent durotomy during decompression lowered the ICP to <5 mm Hg; no further ICP spikes occurred. His postoperative course was uneventful, and 14-month later, he was dramatically improved. Conclusion: ICP monitoring may be a useful adjunct for patient safety in selected patients who are at risk for developing intracranial hypertension during extensive spinal deformity surgery.
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Affiliation(s)
- Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jesse J Liu
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Zachary J Tempel
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Phillip A Choi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert A Hart
- Department of Orthopedic Surgery, Oregon Health and Science University, Portland, OR, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Straka C, Ying J, Kong FM, Willey CD, Kaminski J, Kim DWN. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome. SPRINGERPLUS 2016; 5:229. [PMID: 27026923 PMCID: PMC4771672 DOI: 10.1186/s40064-016-1900-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/17/2016] [Indexed: 12/25/2022]
Abstract
Superior vena cava syndrome (SVCS) is a relatively common sequela of mediastinal malignancies and may cause significant patient distress. SVCS is a medical emergency if associated with laryngeal or cerebral edema. The etiologies and management of SVCS have evolved over time. Non-malignant SVCS is typically caused by infectious etiologies or by thrombus in the superior vena cava and can be managed with antibiotics or anti-coagulation therapy, respectively. Radiation therapy (RT) has long been a mainstay of treatment of malignant SVCS. Chemotherapy has also been used to manage SVCS. In the past 20 years, percutaneous stenting of the superior vena cava has emerged as a viable option for SVCS symptom palliation. RT and chemotherapy are still the only modalities that can provide curative treatment for underlying malignant etiologies of SVCS. The first experiences with treating SVCS with RT were reported in the 1970’s, and several advances in RT delivery have subsequently occurred. Hypo-fractionated RT has the potential to be a more convenient therapy for patients and may provide equal or superior control of underlying malignancies. RT may be combined with stenting and/or chemotherapy to provide both immediate symptom palliation and long-term disease control. Clinicians should tailor therapy on a case-by-case basis. Multi-disciplinary care will maximize treatment expediency and efficacy.
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Affiliation(s)
- Christopher Straka
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Rd, Dallas, TX 75390 USA
| | - James Ying
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Rd, Dallas, TX 75390 USA
| | - Feng-Ming Kong
- Department of Radiation Oncology, GRU Cancer Center and Medical College of Georgia, Augusta, GA USA
| | - Christopher D Willey
- Department of Radiation Oncology, The University of Alabama Birmingham, Birmingham, AL USA
| | - Joseph Kaminski
- Dattoli Cancer Center, 2803 Fruitville Rd, Sarasota, FL 34237 USA
| | - D W Nathan Kim
- Department of Radiation Oncology, Texas Oncology, 1700 W. Highway 6, Waco, TX 76712 USA
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Treating the Unexpected: Metastatic Hepatomegaly Causing Severe Superior Vena Cava Obstruction; Review of the Literature. Clin Breast Cancer 2015; 15:e205-7. [PMID: 25682065 DOI: 10.1016/j.clbc.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 11/22/2022]
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