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Arshad AM, Pandiyan APS, Ayub II, Chockalingam C, Thangaswamy D. Endovascular stenting for malignant superior vena cava syndrome - Case series and review of literature. Lung India 2023; 40:165-168. [PMID: 37006102 PMCID: PMC10174651 DOI: 10.4103/lungindia.lungindia_687_21] [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: 11/27/2021] [Revised: 07/25/2022] [Accepted: 11/13/2022] [Indexed: 03/05/2023] Open
Abstract
The treatment of malignant superior vena cava syndrome (SVCS) revolves around radiotherapy and chemotherapy to relieve symptoms with surgery being ruled out due to the advanced stage of malignancy. Primary placement of endovascular stent for palliation of malignant SVCS is not commonly reported in the literature. Here, we present two cases of malignant superior vena cava syndrome with successful relief of symptoms after the placement of endo vascular stent.
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Affiliation(s)
- Abdul Majeed Arshad
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | | | - Irfan Ismail Ayub
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Chandrasekar Chockalingam
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dhanasekar Thangaswamy
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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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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Xu B, Wang Y, Lang D, Wang D, Hu S, Xu Q. Application of kissing technique for the treatment of superior vena cava syndrome. Ann Vasc Surg 2022; 84:279-285. [PMID: 35108553 DOI: 10.1016/j.avsg.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/28/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Superior vena cava syndrome is a series of symptoms caused by compression of the superior vena cava and its main branches. Endovascular therapy is now widely accepted because it offers rapid, safe and effective relief of clinical symptoms. Few reports have described the application of kissing technique for the treatment of superior vena cava syndrome. In this report, we review a series of cases in which superior vena cava syndrome was treated by kissing technique and we share our experience. METHODS Our institute treated 22 patients with SVCS by endovascular intervention from November 2016 to June 2021; among them, the kissing technique was used in 10 cases and achieved satisfactory results. This is a retrospective evaluation and analysis of 10 patients with superior vena cava syndrome who were treated by endovascular intervention using the kissing technique from May 2018 to April 2021 in Hwa Mei Hospital, University of Chinese Academy of Sciences. Based on literatures, we summarize the diagnosis, treatment, and surgical experience. RESULTS All patients underwent the implantation of the kissing stents, and the technical success rate was 100%. The symptoms and signs of intravenous obstruction in all patients were alleviated or disappeared within one to three days after the procedure. During the follow-up period, nine patients remained free from any clinical signs or symptoms, and one patient died one month after the procedure due to the progression of malignant tumors. CONCLUSION As a palliative intervention, the kissing technique for the treatment of superior vena cava syndrome caused by malignant tumors is safe, rapid, and effective. Successful endovascular therapy can quickly relieve symptoms, improve the patient's quality of life, and provide more opportunities for subsequent anti-tumor treatment.
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Affiliation(s)
- Bin Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Yi Wang
- Department of Radiotherapy and chemotherapy, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Dehai Lang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Di Wang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Songjie Hu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Qiyang Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China.
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Contemporary Use of the Femoropopliteal Vein in Vascular Reconstructions. Ann Vasc Surg 2021; 79:145-152. [PMID: 34644634 DOI: 10.1016/j.avsg.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/22/2021] [Accepted: 07/04/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Current practice patterns favor endovascular treatment, resulting in fewer open procedures. When needed, greater saphenous vein and/or prosthetic conduits are considered the first choice for open vascular bypass. However, there is a cohort of patients in which these conduits are either not available or not suitable to address the surgical requirements. One alternative is to use femoropopliteal vein (FPV), an often-overlooked conduit. We report on the contemporary use of FPV in a tertiary vascular institution. METHODS All patients who underwent FPV harvest, as defined by CPT code 35572, between 2005 and 2019 were identified. Patient demographics (sex, age, baseline laboratory values, medical co-morbidities), indication for use of FPV, complications specific to vein harvest, operative details, post-operative course, and outcomes were recorded. RESULTS Ninety patients had harvest of FPV for creation of 123 conduits. In this study, a conduit was defined as a segment of vein used to perfuse a distinctly separate vascular bed. We identified four cohorts in which FPV was used: aorto-iliac reconstruction in 38 patients for infected graft (19), occlusive disease (8), aortitis (5), mycotic aneurysm (5), and malignancy (1); peripheral artery revascularization in 26 patients for ilio-femoral reconstruction (15), femoropopliteal reconstruction (4), upper extremity/cerebrovascular reconstruction (6), and coronary bypass (1); mesenteric revascularization in 20 patients for acute or acute on chronic ischemia (12), chronic ischemia (7) or aneurysm (1); and dialysis access in 6 patients. There was a high incidence of pre-existing comorbid conditions in all groups, but most notably those patients who underwent aorto-iliac reconstruction. Harvest-related or conduit-related complications included compartment syndrome, graft-associated hemorrhage, surgical site infection, and lymphatic complications. Primary graft patency at 3 years was 83% ± 4% (aorto-iliac), 83% ± 6% (peripheral), 100% (mesenteric), and 23% ± 19% (dialysis access, P < 0.001). CONCLUSIONS While use of FPV has potential significant harvest-related, conduit-related, or systemic complications, FPV is useful for a variety of needs, almost universally available, and durable. In the current era where endovascular approach is the focus, FPV should not be forgotten as a potential conduit that can be used for a variety of vascular reconstruction indications.
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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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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: 11] [Impact Index Per Article: 1.8] [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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Fichelle JM, Baissas V, Salvi S, Fabiani JN. [Superior vena cava thrombosis or stricture secondary to implanted central venous access: Six cases of endovascular and direct surgical treatment in cancer patients]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 43:20-28. [PMID: 29425537 DOI: 10.1016/j.jdmv.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
Superior vena cava (SVC) stenosis or thrombosis is a well-known complication of central venous catheterization for endocavitary treatments, hemodialysis, or chemotherapy. In cancer patients, these SVC lesions are often symptomatic due to intimal damage and chemotherapy toxicity. We report our experience with six patients treated between 2007 and 2012 via an endovascular approach (n=5) or a direct surgical approach (n=1). All patients had SVC syndrome with facial edema, headache and upper limb edema. In three cases, the catheter was in place when the clinical symptoms occurred. Duplex Doppler and computed tomography (CT)-angiography identified the following lesions: isolated SVC stenosis (n=2); SVC stenosis with right Pirogoff confluence stenosis (n=1); SVC stenosis associated with left innominate vein thrombosis and right Pirogoff confluence stenosis (n=1); SVC thrombosis affecting azygos flow (n=2). In one patient, the thrombus extended into the right atrium. Five patients underwent endovascular repair via a right jugular approach (n=2) or a double jugular approach (n=3). Treatment involved: SVC angioplasty with stent (n=2); right Pirogoff angioplasty and SVC stent (n=1); kissing angioplasty of both innominate trunks with a SVC stent (n=1); and SVC angioplasty without stent because of an incomplete result with a residual lumen less than 8mm (n=1). One patient had a complete SVC occlusion with extension of thrombus into the right atrium. She was treated via a median sternotomy for open surgical control of both innominate trunks and lateral clamping of the right atrium. A long cavotomy prolonged on the right atrium allowed thrombo-intimectomy and pericardial patch angioplasty. Postoperative follow-up was uneventful in five cases. However, postoperative hemorrhage required pericardial drainage in one patient. The CT scan showed a good morphological aspect in five patients and an incomplete result in one case. Patients have been followed up annually with a duplex scan from two to six years. One patient had a restenosis at 7 months treated by a new angioplasty via a femoral approach. A new catheter was positioned via a cervical approach. Two patients died of metastatic diffusion at 8 and 32 months. The other four patients have remained asymptomatic, with a satisfactory duplex scan. In conclusion, VCS lesions after implanted central access for chemotherapy can often be treated endovascularly. Conventional surgery still has indications when lesions extend into the right atrium.
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Affiliation(s)
- J M Fichelle
- Clinique Bizet, 21, rue Georges-Bizet, 75116 Paris, France; Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - V Baissas
- Clinique Bizet, 21, rue Georges-Bizet, 75116 Paris, France; Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - S Salvi
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J N Fabiani
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Abstract
Background The use of autologous superficial femoral veins (SFV) as an arterial or venous substitute represents a valuable technique in modern vascular surgery with versatile indications. The SFV autografts exhibit excellent control of infection and durable long-term results in terms of graft patency in prosthetic or arterial infections. In cases of elective use of the SFV, duplex ultrasound evaluation of the deep leg vein system should be implemented to confirm the patency of the profunda femoris vein. Material and methods The SFV can be harvested distal to the adductor hiatus with a proximal portion of the popliteal vein but should not exceed the level of the knee joint. Formation of a stump of the proximal SFV must be avoided. Simultaneous harvesting of the ipsilateral greater saphenous vein should be avoided to reduce the risk of significant chronic edema. Results Early postoperative swelling of the donor leg can be expected but resolves spontaneously in most cases. Chronic mild edema of the leg with a possible indication for compression therapy may occur in up to 20 % of cases but severe complications are very rare if the anatomical borders for vein harvesting are respected. Temporary therapeutic anticoagulation after vein harvest is subject to individual decision making. Conclusion Duplex ultrasound is a reliable tool to assess the residual deep and superficial venous system in the long term. Excellent graft function and the tolerable adverse effects of vein harvest on the donor leg justify the use of the SFV in arterial and venous vascular surgery if indicated.
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Percutaneous endovascular management of chronic superior vena cava syndrome of benign causes : long-term follow-up. Eur Radiol 2016; 27:97-104. [DOI: 10.1007/s00330-016-4354-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/03/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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Bypass porto-mesentérico con vena femoral superficial tras resección de adenocarcinoma de cabeza de páncreas. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gong ZH, Yan LJ, Sun JG. Postoperative radiotherapy to stabilize a tumor embolus in clear cell renal cell carcinoma: A case report. Oncol Lett 2014; 8:1856-1858. [PMID: 25202425 PMCID: PMC4156207 DOI: 10.3892/ol.2014.2421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/24/2014] [Indexed: 11/18/2022] Open
Abstract
Superior vena cava (SVC) syndrome results from clear cell renal cell carcinoma and is a challenge in clinical practice due to its pathological complexity and a lack of research data. The current study presents a 49-year-old female with symptoms of exertional dyspnea and increased fatigue, which had persisted for 15 months, as well as bilateral edema in the lower limbs for two days. A transesophageal echocardiogram demonstrated a right atrial mass originating from the inferior vena cava (IVC; size, 14×8 cm) that caused a tricuspid inflow obstruction. Following a partial resection of the thrombus, a clear cell renal cell carcinoma was identified by histological examination. The patient received intensity-modulated radiation therapy following refusal of other therapeutic methods. The eleven-month follow-up indicated that the tumor on the kidney and IVC was stable. Intensity-modulated radiation therapy may be beneficial to patients with clear cell renal cell carcinoma and SVC syndrome. However, additional studies are required to obtain further data regarding the treatment of this syndrome.
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Affiliation(s)
- Zhi-Hua Gong
- Department of Oncology, Cancer Institute of People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - Lv-Jun Yan
- Department of Oncology, Cancer Institute of People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - Jian-Guo Sun
- Department of Oncology, Cancer Institute of People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
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