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Guo L, Zhang M, Qin L, Wen J. Superior vena cava occlusion in a 6-year-old child with neuroblastoma: A rare case report. Asian J Surg 2024:S1015-9584(24)01013-3. [PMID: 38824028 DOI: 10.1016/j.asjsur.2024.05.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/18/2024] [Accepted: 05/16/2024] [Indexed: 06/03/2024] Open
Affiliation(s)
- Liping Guo
- Department of Ultrasound, Liuzhou Worker's Hospital, Liuzhou, 545005, Guangxi, China
| | - Min Zhang
- Department of Ultrasound, Liuzhou Worker's Hospital, Liuzhou, 545005, Guangxi, China
| | - Lang Qin
- Department of Ultrasound, Liuzhou Worker's Hospital, Liuzhou, 545005, Guangxi, China
| | - Jia Wen
- Department of Ultrasound, Liuzhou Worker's Hospital, Liuzhou, 545005, Guangxi, China.
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2
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Peng Y, Chang C, Song J, Gan L. Prenatal ultrasound diagnosis of multiple rhabdomyomas in the fetal hearts: A rare case report. Asian J Surg 2024:S1015-9584(24)00962-X. [PMID: 38825420 DOI: 10.1016/j.asjsur.2024.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024] Open
Affiliation(s)
- Yao Peng
- Department of Ultrasound imaging, Postgraduate Union training base of Xiangyang No.1 People's Hospital, School of Medicine, Wuhan University of Science and Technology, Xiangyang, 441000, China
| | - Caihong Chang
- Department of Ultrasound imaging, Postgraduate Union training base of Xiangyang No.1 People's Hospital, School of Medicine, Wuhan University of Science and Technology, Xiangyang, 441000, China
| | - Juan Song
- Department of Ultrasound imaging, Postgraduate Union training base of Xiangyang No.1 People's Hospital, School of Medicine, Wuhan University of Science and Technology, Xiangyang, 441000, China.
| | - Ling Gan
- Department of Ultrasound imaging, Postgraduate Union training base of Xiangyang No.1 People's Hospital, School of Medicine, Wuhan University of Science and Technology, Xiangyang, 441000, China.
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3
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Sapone J, Chalunkal M. Unveiling a Unique Presentation of Superior Vena Cava Syndrome Succeeding a Traumatic Motor Vehicle Crash and Implantable Cardioverter-Defibrillator Lead Placement. Cureus 2024; 16:e61303. [PMID: 38947655 PMCID: PMC11212834 DOI: 10.7759/cureus.61303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Superior vena cava (SVC) syndrome, once a rarity, has seen an uptick in cases with diverse origins. While this disease process is clinically diagnosable, imaging modalities and tissue biopsies further refine interventions. The clinical presentation includes but is not limited to edema of the arms, neck, and head, facial plethora, cyanosis, and or distention of subcutaneous vessels. SVC syndrome can be attributed to extrinsic compression or thrombosis in many cases. If symptoms are not life-threatening, the overall morbidity is based on the underlying root cause. Few cases have been reported with associated death due to epistaxis. However, the obstruction itself can be initially asymptomatic and then slowly progress over months to years. This case report highlights a distinct instance of SVC syndrome with notable risk factors: implantable cardioverter defibrillator placement and prior cardiac trauma status post-intervention.
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Affiliation(s)
- Jenna Sapone
- Internal Medicine, St. Luke's University Health Network, Easton, USA
| | - Mathai Chalunkal
- Internal Medicine, St. Luke's University Health Network, Easton, USA
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4
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Usman S, Cheema MAI, Mustafa S, Iftikhar A. Fatal Hemoptysis With Pleural Effusions Secondary to Superior Vena Cava Obstruction as a Complication of Central Venous Catheterization. Cureus 2024; 16:e59690. [PMID: 38840990 PMCID: PMC11150072 DOI: 10.7759/cureus.59690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
This report outlines a rare case of superior vena cava (SVC) syndrome presenting with hemoptysis in a 33-year-old female Jehovah's Witness patient with a complex medical history, including systemic lupus erythematosus (SLE) and chronic hemodialysis dependency due to end-stage renal disease and a failed renal transplant. The SVC syndrome was attributed to occlusion from a right subclavian dialysis catheter. The management of this case was particularly challenging due to the patient's severe anemia and the development of a tension hemothorax following thoracentesis, compounded by her refusal of blood transfusions in adherence to her religious beliefs. A multidisciplinary approach, incorporating bloodless medical techniques such as erythropoietin and iron infusions alongside surgical interventions without blood transfusion, was successfully employed. This case sheds light on the evolving etiology of SVC syndrome and highlights the uncommon but potentially fatal occurrence of hemoptysis as a complication. It also emphasizes the importance of respecting patient values in complex medical decisions.
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Affiliation(s)
| | | | - Saleem Mustafa
- Internal Medicine, Northwell Health, Port Jefferson, USA
| | - Asma Iftikhar
- Pulmonary and Critical Care Medicine, Northwell Health, Port Jefferson, USA
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5
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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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6
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Crooks R, Davidson L, Elliott K, O'Hara G, Gibson E, Kelly R, McAleese J, Masih I. Bedside physician led US-guided supra-clavicular lymph node biopsy and ROSE (rapid on-site evaluation): SVC obstruction swift management in lung cancer. Respir Med Case Rep 2024; 49:101978. [PMID: 38623376 PMCID: PMC11017039 DOI: 10.1016/j.rmcr.2024.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 04/17/2024] Open
Abstract
Superior vena cava obstruction (SVCO) is an oncological emergency and can often be linked to an underlying lung malignancy. Due to the potential life-threatening risks associated with SVCO, it necessitates urgent diagnosis and management. In this report, we discuss 3 case studies where the use of ultrasound-guided supraclavicular lymph node biopsy was used to obtain a biopsy from patients with SVCO, followed by rapid on-site evaluation (ROSE). The benefits of this technique ensure a more rapid histological diagnosis, while also involving a less invasive procedure for the patient. The histological diagnosis is essential in improving patient outcomes when treating those with SVCO as the recommended treatments vary depending on the underlying type of lung malignancy. Having this information can help the clinician swiftly employ the optimal treatment pathway for the patient.
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Affiliation(s)
- R. Crooks
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - L. Davidson
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - K. Elliott
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - G. O'Hara
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - Eddie Gibson
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - R. Kelly
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - J. McAleese
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - I. Masih
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
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7
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Vakil J, Turk E, Cuartas-Mesa MC, Deenadayalan V, Batra K. Inpatient outcomes for lung cancer patients presenting with superior vena cava thrombosis. Proc AMIA Symp 2024; 37:389-393. [PMID: 38628350 PMCID: PMC11018079 DOI: 10.1080/08998280.2024.2317698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/04/2024] [Indexed: 04/19/2024] Open
Abstract
Background A specific cause of superior vena cava (SVC) syndrome, SVC thrombosis, is a rare but known complication in cancer patients. Early identification and management of SVC thrombosis in lung cancer patients may lead to improved patient outcomes and a reduction in healthcare costs. Methods We studied the racial and socioeconomic differences, length of stay, total hospital charges, and all-cause mortality outcomes in patients with lung cancer with and without SVC thrombosis using data from the National Inpatient Sample. Statistical analysis was performed on STATA. Results A total of 480,750 patients were hospitalized for lung cancer; 720 (0.15%) of these patients had SVC thrombosis. The lung cancer with SVC thrombosis cohort had a statistically higher proportion of Black patients. Patients with lung cancer presenting with SVC thrombosis had an increased hospital length of stay (10 vs 6 days, P < 0.001) and cost ($117,320 vs $80,806, P < 0.005) compared to those without SVC thrombosis. All-cause mortality in patients with lung cancer was 7.7% and the presence of SVC thrombosis significantly increased the odds of inpatient mortality (18.0%). Nonwhite races were associated with higher odds of mortality in lung cancer admissions. Conclusion Race, insurance type, and comorbidities impacted the likelihood of developing SVC thrombosis in patients with lung cancer. SVC thrombosis is a poor prognostic factor for patients with lung cancer. Further studies to evaluate these disparities are warranted.
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Affiliation(s)
- Jay Vakil
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Ekrem Turk
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | | | | | - Kunnal Batra
- Division of Hematology/Oncology, Cook County Health, Chicago, IL, USA
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8
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Monden Y, Une D, Torigoe H, Isoda T, Kamaguchi S, Yoshida K, Hirami Y, Nakai M. Surgical resection of an intraluminal tumor in the azygos vein with an unknown primary site causing superior vena cava syndrome. Thorac Cancer 2024; 15:578-581. [PMID: 38316628 PMCID: PMC10912538 DOI: 10.1111/1759-7714.15233] [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] [Received: 10/28/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Intraluminal tumor in the azygos vein is a rare disease that can cause superior vena cava (SVC) syndrome. Radiotherapy and endovascular stenting with or without chemotherapy are reported to have a high clinical success rate for the management of SVC syndrome with malignancy, but a poor survival rate. Here, we report a 69-year-old man who presented with swelling of the face and upper extremities, who was diagnosed with SVC syndrome caused by an intraluminal tumor in the azygos vein. Enhanced chest computed tomography revealed an intraluminal mass with a filling defect from the azygos vein to the SVC, with no extravascular extension or dissemination of the primary tumor. Surgical resection of the mass en bloc with the azygos vein and SVC reconstruction was performed. A poorly differentiated carcinoma was diagnosed on postoperative pathological evaluation. Twelve months after resection, the patient was well with no signs of recurrent disease. This case highlights that surgical resection should be considered as a treatment of choice for the management of SVC syndrome caused by an intraluminal malignancy in the azygos vein.
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Affiliation(s)
- Yuki Monden
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
| | - Dai Une
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
| | - Hidejiro Torigoe
- Department of Thoracic SurgeryOkayama Medical CenterOkayamaJapan
| | - Tetsuya Isoda
- Department of PathologyOkayama Medical CenterOkayamaJapan
| | - Suzuka Kamaguchi
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
| | - Kenji Yoshida
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
| | - Yuji Hirami
- Department of Thoracic SurgeryOkayama Medical CenterOkayamaJapan
| | - Mikizo Nakai
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
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9
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Zhao QY, Li Q, Cui TL. Risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome. J Vasc Surg Venous Lymphat Disord 2024; 12:101682. [PMID: 37708936 DOI: 10.1016/j.jvsv.2023.08.021] [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] [Received: 03/08/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We analyzed the risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome (SVCS) and effectiveness of endovascular intervention in hypotension related to SVCS. METHODS This was a retrospective cohort study. A total of 194 maintenance hemodialysis patients diagnosed with SVCS who were admitted to the Department of Nephrology, West China Hospital of Sichuan University from January 2019 to December 2021 were selected and divided into a hypotension group and a nonhypotension group. Demographic and clinical data were compared. Hypotension simply refers to blood pressure levels of <90/60 mm Hg on a nondialysis day. All patients received endovascular intervention. RESULTS Hypotension was found in 85 of the 194 patients. The following factors were significantly different between the hypotension and nonhypotension groups: body mass index, history of hypertension, tunneled-cuffed catheter as the means of dialysis access, azygos ectasis, SVC stenosis of >70% or occlusion, occlusion at the cavitary junction, serum calcium, diastolic left ventricular (LV) posterior wall thickness, LV end-diastolic volume, stroke output, and LV ejection fraction. Multivariate logistic regression analysis showed that hypertension history (OR, 0.314; P = .027), tunneled-cuffed catheter as vascular access (OR, 3.997; P < .001), SVC stenosis of >70% or occlusion (OR, 5.243; P < .001), LV posterior wall thickness (OR, 0.772; P = .044), and serum calcium (OR, 0.146; P = .005) were independent risk factors for hypotension. The mean values of systolic and diastolic blood pressure after intravascular treatment were significantly elevated from those before intervention (P < .001). The primary patency rates of SVC were 66.8%, 58.7%, and 50.0% at 3, 6, and 12 months after the procedure. CONCLUSIONS The incidence of hypotension in patients with hemodialysis-associated SVCS is high. The identification of risk factors of hemodialysis-related hypotension provides insight into potential treatment strategies. Endovascular treatment is expected to improve hypotension related to SVCS in hemodialysis patients.
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Affiliation(s)
- Qiu-Yan Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qiu Li
- Department of Nephrology, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Tian-Lei Cui
- Department of Nephrology, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
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10
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Kanaji N, Watanabe N, Inoue T, Mizoguchi H, Sakamoto K, Komori Y, Kawada K, Kadowaki N. Superior vena cava syndrome induced by lung hyperinflation in chronic obstructive pulmonary disease: a case report. J Med Case Rep 2023; 17:497. [PMID: 38037127 PMCID: PMC10691103 DOI: 10.1186/s13256-023-04256-7] [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] [Received: 06/13/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Superior vena cava syndrome is rarely attributed to chronic obstructive pulmonary disease. CASE PRESENTATION We present the case of an 82-year-old Japanese man who experienced gradually progressive dyspnea on exertion. His physical examination revealed small vascular dilatations on his chest and upper abdominal skin characterized by blood flow from head to leg, indicating superior vena cava syndrome. Radiographic findings included lung hyperinflation with a drop-like heart on chest X-ray, and emphysematous changes on computed tomography. The superior vena cava appeared extremely narrow and slit-like, with no adjacent mass or giant bulla. Pulmonary function testing indicated a forced expiratory volume in 1 second of 0.82L (44.4% of predicted value) and a forced expiratory volume in 1 second/forced vital capacity of 31.29%. A diagnosis of chronic obstructive pulmonary disease was made. We discuss how longitudinal forces can narrow the superior vena cava, particularly when it protrudes toward the lung field due to its anatomical location in the upper mediastinum. The absence of mediastinal adipose tissue may render the superior vena cava susceptible to compression, resulting in a loss of its typical columnar structure. The protrusion of the superior vena cava toward the lung field may be a contributing factor to superior vena cava narrowing in chronic obstructive pulmonary disease. CONCLUSION This case represents the first reported instance of superior vena cava syndrome associated with chronic obstructive pulmonary disease, characterized by lung hyperinflation, in the absence of a giant bulla.
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Affiliation(s)
- Nobuhiro Kanaji
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan.
| | - Naoki Watanabe
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Takuya Inoue
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Hitoshi Mizoguchi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Kosuke Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Kita-Gun, Kagawa, Japan
| | - Yuta Komori
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Kosuke Kawada
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Norimitsu Kadowaki
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
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Guerrero-Macías S, Beltrán J, Buitrago R, Beltrán R, Carreño J, Carvajal-Fierro C. Outcomes in patients managed with endovascular stent for malignant superior vena cava syndrome. Surg Open Sci 2023; 16:16-21. [PMID: 37744312 PMCID: PMC10517271 DOI: 10.1016/j.sopen.2023.09.001] [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: 03/29/2023] [Revised: 08/09/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background Malignant Superior Vena Cava Syndrome (SVCS) corresponds to the clinical manifestations due to the restriction of venous return to the right atrium secondary to obstruction of the superior vena cava and/or its main tributaries for a tumor. Endovascular management has proven to be safe, effective and cause a fast symptomatic relief in patients with SVCS. There is limited evidence in factors associated with outcomes in malignant setting for this procedure. Materials and methods An analytical retrospective study was conducted and included patients that underwent endovascular management for malignant SVCS at the National Cancer Institute of Colombia between May 2016 and May 2021. Clinical and technical variables were analyzed to found associations with outcomes in these patients. Results 54 patients were analyzed. Successful procedure rate was 94.4 %. At 10 months, the OS of the entire cohort of patients was 25 %. Patients with breast or lung cancer (P = 0.031), unsuccessful procedure (P = 0.011), and also with short time of symptoms to the date of the endovascular procedure (P = 0.027) had worse OS. Multivariate analysis showed that lung cancer [HR = 2.55, 95%IC:(1.21-5.36)] and left internal jugular vein or left Innominate vein distal stent attachment [HR = 3.27, 95%IC:(1.31-8.15)] were independent factors for worst OS. Conclusions Based in the high success rate of the endovascular management and the better outcome in patients with early and successful procedure, this procedure should be considered as part of the multimodal treatment in patients with SVCS independent of the clinical scenario and the oncological diagnosis.
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Affiliation(s)
- S. Guerrero-Macías
- Surgical Oncology Fellow, Instituto Nacional de Cancerología, Bogotá 111511, Colombia
| | - J. Beltrán
- Interventional Radiologist, Instituto Nacional de Cancerología, Bogotá 111511, Colombia
| | - R. Buitrago
- Thoracic Surgeon, Thoracic Surgery Department, Instituto Nacional de Cancerología, Bogotá 111511, Colombia
| | - R. Beltrán
- Thoracic Surgeon, Thoracic Surgery Department, Instituto Nacional de Cancerología, Bogotá 111511, Colombia
| | - J. Carreño
- Research Department, Instituto Nacional de Cancerología, Bogotá 111511, Colombia
| | - C. Carvajal-Fierro
- Thoracic Surgeon, Thoracic Surgery Department, Instituto Nacional de Cancerología, Bogotá 111511, Colombia
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12
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Desai P, Mistry D, Kothari J, Gupta A, Panchagnula K, Singh G, Baskar A, Pathak Y. A Case of a Constricted Vessel: The Impact of Acute Myeloid Leukemia on the Superior Vena Cava. Cureus 2023; 15:e49616. [PMID: 38161934 PMCID: PMC10755333 DOI: 10.7759/cureus.49616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Acute myeloid leukemia (AML) is the most prevalent form of leukemia in adults, with rising global incidence rates. AML usually presents with non-specific clinical features such as pallor, fever, and bleeding. This case report discusses a unique presentation of AML, where a 25-year-old female with a history of hypertension presented with unilateral facial swelling, chest pain, and shortness of breath. Radiologic investigations revealed a mediastinal mass encasing the superior vena cava (SVC), confirming the suspicion of SVC syndrome. Upon testing with a biopsy, the mass was found to be composed of immature myeloid cells confirming the diagnosis of myeloid sarcoma-associated AML. The patient's treatment involved a combination of surgical debridement, induction chemotherapy, supportive care, and management of complications. This case highlights that despite its common occurrence, AML may present with atypical clinical manifestations such as SVC syndrome, posing challenges in its diagnosis and timely management.
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Affiliation(s)
- Paavan Desai
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Bhuj, IND
| | - Dhruvish Mistry
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Bhuj, IND
| | - Jhanvi Kothari
- Internal Medicine, Gujarat Medical Education & Research Society (GMERS) Medical College and Hospital, Gandhinagar, IND
| | - Ashima Gupta
- Internal Medicine, Dr. Panjabrao Alias Bhausaheb Deshmukh Memorial Medical College, Amravati, IND
| | | | - Gurinder Singh
- Internal Medicine, Universidad Latina de Panama, Panama, PAN
| | - Aakash Baskar
- Internal Medicine, K.A.P. Viswanatham Government Medical College, Tiruchirappalli, IND
| | - Yashash Pathak
- Internal Medicine, Baylor St. Luke's Medical Center, Houston, USA
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13
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Wright K, Digby GC, Gyawali B, Jad R, Menard A, Moraes FY, Wijeratne DT. Malignant Superior Vena Cava Syndrome: A Scoping Review. J Thorac Oncol 2023; 18:1268-1276. [PMID: 37146753 DOI: 10.1016/j.jtho.2023.04.019] [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] [Received: 11/09/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/07/2023]
Abstract
Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. This may occur due to external compression, neoplastic invasion of the vessel wall, or internal obstruction with bland or tumor thrombus. Although symptoms are typically mild, SVCS can cause neurologic, hemodynamic, and respiratory compromise. Classic management options include supportive measures, chemotherapy, radiation therapy, surgery, and endovascular stenting. New targeted therapeutics and techniques have also recently been developed, which may have a role in management. Nevertheless, few evidence-based guidelines exist to guide treatment of malignant SVCS, and these recommendations are typically restricted to individual disease sites. Furthermore, there are no recent systematic literature reviews that address this question. Here, we present a theoretical case to frame this clinical problem and synthesize updated evidence published in the past decade relating to the management of malignant SVCS through a comprehensive literature review.
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Affiliation(s)
- Kristin Wright
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Geneviève C Digby
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Respirology, Queen's University, Kingston, Ontario, Canada
| | - Bishal Gyawali
- Department of Oncology, Queen's University, Kingston, Ontario, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Reem Jad
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandre Menard
- Department of Diagnostic Imaging, Queen's University, Kingston, Ontario, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Don Thiwanka Wijeratne
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health, Queen's University, Kingston, Ontario, Canada; Division of General Internal Medicine, Queen's University, Kingston, Ontario, Canada
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14
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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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15
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Rashwan B, Shwaiki O, Partovi S, Karuppasamy K, Gill A, Gadani S. Thoracic central venous occlusion from the interventional radiology perspective. Cardiovasc Diagn Ther 2023; 13:299-310. [PMID: 36864973 PMCID: PMC9971304 DOI: 10.21037/cdt-22-93] [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: 02/19/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Central venous occlusion is a common condition in certain patient populations, with significant associated morbidity. Symptoms range from mild arm swelling to respiratory distress and can be particularly troublesome in the end stage renal disease population when related to dialysis access and function. Crossing completely occluded vessels is often the most challenging step and various techniques exist to accomplish this. Traditionally, blunt and sharp recanalization techniques are used to cross occluded vessels and are described in detail. Even with experienced providers there are lesions which prove to be too difficult and are refractory to traditional approaches. We discuss advanced techniques such as with radiofrequency guidewires as well as newer technologies which offer an alternative pathway to re-establishing access. These emerging methods have demonstrated procedural success in the majority of cases where traditional techniques were futile. Following recanalization, angioplasty with or without stenting is typically performed and restenosis is a commonly encountered complication. We discuss angioplasty and the emerging use of drug-eluting balloons in venous thrombosis. Subsequently, in regards to stenting we discuss the indications and multitude of available types including novel venous stents with their respective strengths and drawbacks. Potential feared complications such as venous rupture with balloon angioplasty and stent migration are discussed along with our recommendations to reduce their risk of occurrence and promptly manage them when they do unfortunately occur.
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Affiliation(s)
- Basem Rashwan
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Omar Shwaiki
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sasan Partovi
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Amanjit Gill
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sameer Gadani
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
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16
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Black AK, Tom MC. Collateral Vascularization in Chronic Superior Vena Cava Syndrome. Mayo Clin Proc 2023; 98:348-349. [PMID: 36737124 DOI: 10.1016/j.mayocp.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/21/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Alexander K Black
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL.
| | - Martin C Tom
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL
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17
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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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18
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Affiliation(s)
- Florence Morriello
- Temetry Faculty of Medicine (Morriello, Brown, Granton, Bonta), University of Toronto; Divisions of General Internal Medicine (Morriello, Bonta), Vascular and Interventional Radiology (Brown) and Respirology (Granton) University of Toronto, Toronto, Ont.; Division of General Internal Medicine (Morriello), Department of Medicine, Northern Ontario School of Medicine, Sudbury, Ont.
| | - Andrew Brown
- Temetry Faculty of Medicine (Morriello, Brown, Granton, Bonta), University of Toronto; Divisions of General Internal Medicine (Morriello, Bonta), Vascular and Interventional Radiology (Brown) and Respirology (Granton) University of Toronto, Toronto, Ont.; Division of General Internal Medicine (Morriello), Department of Medicine, Northern Ontario School of Medicine, Sudbury, Ont
| | - John Granton
- Temetry Faculty of Medicine (Morriello, Brown, Granton, Bonta), University of Toronto; Divisions of General Internal Medicine (Morriello, Bonta), Vascular and Interventional Radiology (Brown) and Respirology (Granton) University of Toronto, Toronto, Ont.; Division of General Internal Medicine (Morriello), Department of Medicine, Northern Ontario School of Medicine, Sudbury, Ont
| | - Mark Bonta
- Temetry Faculty of Medicine (Morriello, Brown, Granton, Bonta), University of Toronto; Divisions of General Internal Medicine (Morriello, Bonta), Vascular and Interventional Radiology (Brown) and Respirology (Granton) University of Toronto, Toronto, Ont.; Division of General Internal Medicine (Morriello), Department of Medicine, Northern Ontario School of Medicine, Sudbury, Ont
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19
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Baruah U, Begum D, Barmon D, Aparajita. Superior Vena Cava Syndrome: An Occurrence of Surprise in Gynecological Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00657-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Komatsu T, Miura T, Nomoto F, Itagaki T, Sunohara D, Mochidome T, Kasai T, Ikeda U. Successful treatment of recurrent superior vena cava syndrome due to pulmonary adenocarcinoma using intravascular ultrasound. J Cardiol Cases 2022; 27:76-79. [PMID: 36788957 PMCID: PMC9911930 DOI: 10.1016/j.jccase.2022.10.008] [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: 12/20/2021] [Revised: 08/02/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
Patients with malignant diseases may develop symptoms of superior vena cava syndrome (SVCS) quickly because rapid tumor growth does not allow adequate time to develop collateral blood flow. Therefore, malignant SVCS is a medical emergency associated with neurological or pharyngeal-laryngeal signs. Recently, interventional endovascular treatment (EVT) has achieved acceptable results. We describe the case of a 55-year-old woman with pulmonary adenocarcinoma and laryngeal edema. In the first EVT, bare-metal-stent was implanted into the SVCS with intravascular ultrasound (IVUS) guidance. The IVUS showed insufficient stent-mid expansion. We did not use additional ballooning because of the risk of superior vena cava (SVC) rupture. Three months later, the SVCS recurred. A second EVT was performed, and IVUS imaging suggested tumor ingrowth into the SVC through the stent struts. We considered that the tumor ingrowth could be covered in the SVC using stent-graft. The patient showed no recurrence of SVCS for about 12 months. IVUS-guided implantation of stent for the treatment of malignant SVCS has not been reported. This case report revealed that stent therapy using IVUS for SVCS is useful. Learning objective Superior vena cava syndrome (SVCS) due to malignancy is not rare. Recently, endovascular treatment for SVCS has achieved acceptable results. However, SVC stenting in SVCS as having primary patency rate varies for each report. Intravascular ultrasound (IVUS) guided implantation of stent for malignant SVCS treatment has not been reported. In this case, we suspected insufficient stent expansion and tumor ingrowth as the possible cause of in-stent restenosis. Therefore, stent therapy using IVUS for malignant SVCS can be helpful.
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Affiliation(s)
- Toshinori Komatsu
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan,Department of Cardiology, Shinshu University Hospital, Nagano, Japan,Corresponding author at: Department of Cardiology, Nagano Municipal Hospital, Tomitake 1333-1, Nagano 381-8551, Japan.
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Fumika Nomoto
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Tadashi Itagaki
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Daisuke Sunohara
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan,Department of Cardiology, Shinshu University Hospital, Nagano, Japan
| | | | - Toshio Kasai
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Uichi Ikeda
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
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21
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Sy E, Zacharias S, Lee JS. Neck Swelling in a Critically Ill Patient With COVID-19-Related Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation: Consider the Differential. Cureus 2022; 14:e30877. [DOI: 10.7759/cureus.30877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
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22
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Moore CM, Loichle A, Tavakolian K, Odak M, Nightingale S, Patel SV. A Rare Case of Superior Vena Cava Syndrome in a Patient With Rheumatoid Arthritis and IgA Nephropathy. Cureus 2022; 14:e28198. [PMID: 36003344 PMCID: PMC9392423 DOI: 10.7759/cureus.28198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 11/05/2022] Open
Abstract
Superior vena cava syndrome (SVCS) is a vascular condition resulting from an impaired venous return to the right atrium. The majority of SVCS cases are caused by mass effect in which extrinsic compression of the vessel leads to obstruction of blood flow. In less common cases of SVCS, thrombus formation and luminal narrowing can result in poor return through the SVC. Inflammatory causes of SVCS are even rarer and poorly documented. IgA nephropathy and rheumatoid arthritis (RA) are two autoimmune diseases with the potential to cause vasculitis, thus increasing the likelihood of intraluminal vessel occlusion. We report a rare case of SVCS in a 65-year-old female with a past medical history significant for atrial fibrillation, IgA nephropathy, chronic kidney disease stage IIIA, and RA who presented with headache, dizziness, and neck pain and swelling extending down the left upper extremity for three days. Inflammatory SVCS is uncommon and cases of SVCS secondary to RA and IgA nephropathy are underreported in the literature thus far. Our hope in presenting this case is to encourage a greater degree of suspicion for vascular complications, such as SVCS, in patients with autoimmune and inflammatory conditions.
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23
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Esposito KD, Shariff MA, Freiberg A, Evangelista MCA. Superior Vena Cava Syndrome: A Palliative Approach to Treatment. Cureus 2022; 14:e27889. [PMID: 36110489 PMCID: PMC9464010 DOI: 10.7759/cureus.27889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Superior vena cava (SVC) syndrome is an oncologic emergency of venous congestion due to impaired venous flow through the SVC to the right atrium, leading to potential hemodynamic instability. We report a case of a 78-year-old female patient with a non-symptomatic lung nodule that exhibited rapid growth from its discovery to an enlarging tumor impinging the SVC in less than one month. The short time span from computed tomography (CT) image of the tumor to oncologic emergency required our team to act quickly to identify the source of the tumor and halt its progression, utilizing a multidisciplinary team approach while dealing with a patient that executed their right of autonomy to refusal of care, thus focusing on management with palliative goals since SVC syndrome has a life expectancy of six months post-diagnosis.
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24
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A case of primary mediastinal seminoma with superior vena cava syndrome and large intracardiac thrombus. Int J Surg Case Rep 2022; 97:107478. [PMID: 35952569 PMCID: PMC9403337 DOI: 10.1016/j.ijscr.2022.107478] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Primary mediastinal seminoma is rare, especially with complications of superior vena cava syndrome (VCSS) and large thrombus. CASE PRESENTATION A 23-years-old Indonesian male complained of dyspnea, phlegm cough, chest pain, and body weight loss. The patient experienced swelling in the face and neck 1 week ago, accompanied by increased jugular venous pressure. Radiological results showed a firm mass in the right area of the mediastinum. Tumor marker and IHC results showed mediastinal seminoma. Electrocardiography showed sinus tachycardia, right axis deviation, and V1-V5 slow R wave progression. Echocardiography showed an intracardiac mass (RA protrusive RV, size 7.2 × 3.8 cm) with an intracardiac thrombus and RV failure. The patient was positioned in a semi-Fowler's position and given furosemide 3 × 20 mg, dexamethasone 3 × 5 mg, and warfarin 1 × 4 mg. Meanwhile, the results of the biopsy revealed a malignant germ cell tumor. When the patient was going to have bronchoscopy and radiotherapy planned, the patient died. DISCUSSION Reporting primary mediastinal seminoma cases with complications of VCSS and large thrombus has a high risk of mortality, so this report can be used as a review to improve management in future. CONCLUSION Mediastinal seminoma with complications has a high mortality.
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25
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Trivedi SB, Ray C, Chadalavada S, Makramalla A, Kord A. Superior Vena Cava Syndrome: An Update and Literature Review of Percutaneous Endovascular Treatments. Semin Intervent Radiol 2022; 39:446-453. [PMID: 36406024 PMCID: PMC9671675 DOI: 10.1055/s-0042-1757344] [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]
Affiliation(s)
- Surbhi B. Trivedi
- Division of Interventional Radiology, Department of Radiology, the University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Charles Ray
- Division of Interventional Radiology, Department of Radiology, the University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Seetharam Chadalavada
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Abouelmagd Makramalla
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
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26
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Quencer KB. Superior Vena Cava Syndrome: Etiologies, Manifestations, and Treatments. Semin Intervent Radiol 2022; 39:292-303. [PMID: 36062219 PMCID: PMC9433155 DOI: 10.1055/s-0042-1753480] [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: 10/14/2022]
Abstract
Superior vena cava (SVC) obstruction, whether from benign or malignant causes, results in a variety of symptoms. It is a potential medical emergency when cerebral or laryngeal edema occurs. Endovascular therapy is the treatment of choice for patients in need of emergent relief of symptoms. This article will provide a review of SVC syndrome with a focus on endovascular treatment techniques.
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Affiliation(s)
- Keith B. Quencer
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
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27
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Haider MS, Master MF, Atluri S, Nfonoyim J. Superior Vena Cava Syndrome Due to Thrombosis: A Case Report. Cureus 2022; 14:e24811. [PMID: 35686261 PMCID: PMC9172051 DOI: 10.7759/cureus.24811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
Abstract
Superior vena cava (SVC) syndrome is a clinical entity with signs and symptoms resulting from obstruction of blood flow through the SVC. The resulting obstruction leads to edema in the upper body, including the head, neck, and upper extremities. Clinical signs and symptoms can include plethora, cyanosis, dyspnea, stridor, cough, and hoarseness, as well as more serious complications such as cerebral edema leading to headache, confusion, and coma. Here, we present an interesting case of a 66-year-old female, with a medical history of esophageal cancer in remission and thyroid cancer currently undergoing radiation therapy, who was admitted for facial and upper extremity swelling. The initial impression was of angioedema or an allergic reaction. Imaging studies showed thrombus in the SVC resulting in SVC syndrome. The patient was treated with heparin initially, with a plan for an interventional radiologist to perform catheter-guided thrombolysis. However, the patient became unstable and ended up requiring mechanical ventilation. The patient was eventually discharged on oral anticoagulants. This case was rare as the patient developed SVC syndrome from venous thrombosis in the absence of any external tumor compression or as a result of an intravascular catheter.
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28
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Luo H, Ge H. Application of Proteomics in the Discovery of Radiosensitive Cancer Biomarkers. Front Oncol 2022; 12:852791. [PMID: 35280744 PMCID: PMC8904368 DOI: 10.3389/fonc.2022.852791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/04/2022] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy remains an important component of cancer treatment. Gene-encoded proteins were the actual executors of cellular functions. Proteomic was a novel technology that can systematically analysis protein composition and measure their levels of change, this was a high throughput method, and were the import tools in the post genomic era. In recent years, rapid progress of proteomic have been made in the study of cancer mechanism, diagnosis, and treatment. This article elaborates current advances and future directions of proteomics in the discovery of radiosensitive cancer biomarkers.
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Affiliation(s)
- Hui Luo
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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29
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Patriarcheas V, Grammoustianou M, Ptohis N, Thanou I, Kostis M, Gkiozos I, Charpidou A, Trontzas I, Syrigos N, Kotteas E, Dimakakos E. Malignant Superior Vena Cava Syndrome: State of the Art. Cureus 2022; 14:e20924. [PMID: 35004083 PMCID: PMC8727327 DOI: 10.7759/cureus.20924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/05/2022] Open
Abstract
Superior vena cava syndrome (SVCS) is a clinical entity characterized by signs and symptoms arising from the obstruction or occlusion of the thin-walled superior vena cava (SVC) and can result in significant morbidity and mortality. Despite the rise of benign cases of SVCS, as a thrombotic complication of intravascular devices, it is most commonly seen secondary to malignancy as a consequence of thrombosis, direct invasion of tumor cells inside the vessel, or external compression. SVCS can be the initial presentation of a previously undiagnosed tumor in up to 60% of cases. Lung cancer and non-Hodgkin lymphoma (NHL) are responsible for up to 85%-90% of malignancy-related SVCS, while metastatic cancers account for approximately 10%. Herein, we review the pathophysiology, etiology, clinical presentation, diagnosis, and management of malignancy-related SVCS.
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30
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Naik V, Cheruku D, Swathi U, Rayani B. Femoral peripherally inserted central catheter in superior vena cava syndrome - Challenges of tunnelling. Indian J Anaesth 2022; 66:388-389. [PMID: 35782665 PMCID: PMC9241194 DOI: 10.4103/ija.ija_476_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 02/16/2022] [Accepted: 04/15/2022] [Indexed: 12/05/2022] Open
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Tumor mass in the lung with superior vena cava syndrome. ARCHIVE OF ONCOLOGY 2022. [DOI: 10.2298/aoo200521002p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Group of symptoms due to vena cava superior obstruction is named superior vena cava syndrome. A 65-year-old female, long-standing smoker was presented with a two-week history of dry cough and facial swelling. The patient noticed a palpable mass on the right side of the neck. Computer tomography scan with contrast showed extensive, irregular, non-homogenous consolidation in the right upper lobe, involving the right hilus, surrounding the aortic arch, supra aortic branches and pleural effusion at the right side of the body. Also, ultrasound examination of supra clavicular space showed enlarged pathologic hypoehogenic lymph node without an echogenic hilum. Ultrasound guided fine needle biopsy of lymph node was performed, and cytopathology findings showed metastatic lesion from primary microcellular lung cancer, IIIC stadium, cT4N3M0. Venous angioplasty was performed showing stenosis in the superior vena cava. After balloon dilatation, the stent was placed at the site of stenosis. The patient received chemio- and radiotherapy and survival time was seven months. Superior vena cava syndrome is an urgent clinical condition, and lung cancer is the leading cause of this syndrome. Computer tomography imaging findings and endovascular stent placement are important for detection and management of the superior vena cava thrombosis.
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32
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Wu Y, Li Y, Wang M, Li W, Qiu X. Percutaneous Endovascular Stent Placement for Treatment of Malignant Superior Vena Cava Syndrome: A Retrospective Review. Ann Vasc Surg 2021; 80:325-332. [PMID: 34780937 DOI: 10.1016/j.avsg.2021.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/22/2021] [Accepted: 10/03/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We assessed the safety as well as the efficacy of self-expanding stent placement for the treatment of malignant superior vena cava syndrome (SVCS), besides identifying the predictable probable factors for the clinical improvement of endovascular stent treatment in SVCS. METHODS The study reviewed 112 patients (92 men) with malignant SVCS retrospectively from January 2015 to December 2020. RESULTS Out of total 112 patients, 106 stents were successfully placed in 102 patients, however 4 patient's occlusions could not be passed and 6 patient's procedure was abandoned due to intraluminal thrombus as detected in venography. In 92 patients, complete resolution of syndrome was observed within 72 hrs but 10 patients did not to intervention. In 102 patients, procedure-related 8 complications were noted including stent migrations (n = 4), pulmonary embolism (n = 2), and pulmonary edemas (n = 2). Besides after stenting, 3 hemorrhages with anticoagulation therapy were observed with 4 recurrences at 22, 36, 51 and day 58 in 6 months. The pressure gradient across the lesion (≥ 20mmHg) was used as a predictor for clinical efficacy of stent therapy for SVCS. CONCLUSIONS Endovascular stent insertion is a safe and effective intervention for malignant SVCS, especially for those with pressure gradient across the lesions ≥ 20mmHg.
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Affiliation(s)
- Yilin Wu
- Department of Cardiology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yanjie Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Wang
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Weizhen Li
- Department of Cardiology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xingbiao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
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Potere B, Boulos R, Awad H, Taylor A, Kneuertz PJ, Cline M, Meyers L, Essandoh M, Henn M, Dalton R. The Role of Extracorporeal Membrane Oxygenation in the Anesthetic Management of Superior Vena Cava Syndrome: Is it Time to Use a Scoring System? J Cardiothorac Vasc Anesth 2021; 36:1777-1787. [PMID: 34531109 DOI: 10.1053/j.jvca.2021.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Bethany Potere
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Racha Boulos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Ashley Taylor
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Kneuertz
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael Cline
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lori Meyers
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Matthew Henn
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ryan Dalton
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
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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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Lopez-Bauza A, Jara-Palomares L. Symptomatic azygous vein thrombosis: Clinical case and literature review. Arch Bronconeumol 2021; 57:506-509. [PMID: 35698966 DOI: 10.1016/j.arbr.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Angela Lopez-Bauza
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain
| | - Luis Jara-Palomares
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain.
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Clinical analysis of 48 cases of malignant superior vena cava syndrome. World J Surg Oncol 2021; 19:185. [PMID: 34162380 PMCID: PMC8223363 DOI: 10.1186/s12957-021-02300-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background The aim of our study was to observe and compare the curative effect of radiotherapy, chemotherapy, and combined radiotherapy and chemotherapy, as well as comprehensive treatment on superior vena cava syndrome (SVCS) caused by malignant etiology. Methods A total of 48 patients with malignant SVCS admitted to our hospital from 2015 to 2020 were selected in this study. According to the different treatment methods, they were divided into radiotherapy group (group 1, 10 cases), chemotherapy group (group 2, 8 cases), combined radiotherapy and chemotherapy group (group 3, 22 cases), and comprehensive treatment group (group 4, 8 cases). Results There were no significant differences in efficacy and side effects among the four groups (all P > 0.05). Group 4 (median survival time of 36 months) could provide longer survival time than groups 1, 2, and 3 (median survival time of 10 months, 13.5 months, and 12 months, respectively). Conclusions For patients with severe symptoms or good prognosis, comprehensive treatment could be selected to improve the quality of life and prolong the survival period; for patients with mild symptoms, radiotherapy, chemotherapy, or combined radiotherapy and chemotherapy could also reduce the symptoms of SVCS and treat tumor lesions.
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Tsang DS, Vargo JA, Goddard K, Breneman JC, Kalapurakal JA, Marcus KJ. Palliative radiation therapy for children with cancer. Pediatr Blood Cancer 2021; 68 Suppl 2:e28292. [PMID: 33818881 DOI: 10.1002/pbc.28292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/03/2020] [Accepted: 03/14/2020] [Indexed: 11/08/2022]
Abstract
Radiation therapy (RT) is often used as a palliative treatment for children with recurrent malignant disease to ameliorate or prevent symptoms. However, no guidelines exist regarding the clinical indications or dose fractionation for palliative RT. The goal of this report is to provide guidelines for the use of palliative RT in children with cancer. In this guideline, appropriate indications for palliative RT, recommended dose-fractionation schedules, relevant toxicities, and avenues for future research are explored. RT is an effective palliative treatment for bone, brain, liver, lung, abdominopelvic and head-and-neck metastases, spinal cord compression, superior vena cava syndrome, and bleeding. Single-fraction regimens (8 Gy in one fraction) for children with short life expectancy are recommended for simple, uncomplicated bone metastases and can be considered for some patients with lung or liver metastases. A short, hypofractionated regimen (20 Gy in five fractions) may be used for other indications to minimize overall burden of therapy. There are little data supporting use of more prolonged fractionation regimens, though they may be considered for patients with very good performance status. Future research should focus on response and outcomes data collection, and to rigorously evaluate the role of stereotactic body RT in well-designed, prospective studies.
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Affiliation(s)
- Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - John Austin Vargo
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen Goddard
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - John C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern Medicine, Chicago, Illinois
| | - Karen J Marcus
- Division of Radiation Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
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Rêgo Salgueiro F, Vieira I, Gomes I, Petrova M. Primary angiosarcoma of superior vena cava: an unexpected diagnosis after an oncological emergency. BMJ Case Rep 2021; 14:14/4/e241266. [PMID: 33863773 PMCID: PMC8055115 DOI: 10.1136/bcr-2020-241266] [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: 11/04/2022] Open
Abstract
Angiosarcoma (AS) is a rare malignant tumour representing 1%-2% of all sarcomas. Primary AS of superior vena cava (SVC) was reported in two cases worldwide. We report a 69-year-old woman with neck discomfort, headache and dyspnoea for 3 months. CT angiography showed thrombosis in SVC and brachiocephalic veins resulting in an SVC syndrome. The patient began anticoagulant therapy and underwent balloon angioplasty with clinical improvement. Additionally, a positron emission tomography scan confirmed the presence of a mediastinal mass involving the SVC locally. The tumour was excised and a prosthesis was placed on the SVC. Histology revealed a heterogeneous tumour matrix, either myxoid and composed by fusiform cells with vimentin, homogeneous CD31 and a 30% Ki67 immunoexpression, supporting the diagnosis of an AS. Due to multiple complications, the patient never started chemotherapy, and after tumour recurrence, she died within 5 months after diagnosis.
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Affiliation(s)
- Fábio Rêgo Salgueiro
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Inês Vieira
- Endocrinology and Metabolism, Centro Hospitalar Universitário de Coimbra EPE, Coimbra, Portugal
| | - Inês Gomes
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Maja Petrova
- Internal Medicine, Centro Hospitalar Universitário de Coimbra EPE, Coimbra, Portugal
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Lingegowda D, Gupta B, Gehani A, Ghosh P, Mukhopadhyay S. Endovascular Stenting for Malignant Obstruction of Superior Vena Cava: A Single-Center Experience Using the Body Floss Technique. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1728975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Purpose Endovascular stenting is the treatment of choice for malignant obstruction of the superior vena cava (SVC) when rapid symptomatic relief is desired. Body floss technique is not routinely used during SVC stenting but has few advantages over single-access technique. We report our experience with stenting for malignant obstruction of the SVC using the body floss technique.
Materials and Methods Between March 2015 and March 2020, 25 patients (20 men, 5 women; median age, 65 years) with malignant SVC obstruction underwent endovascular stenting of the SVC. We retrospectively evaluated these patients for clinical and technical success rates, complications, recurrence-free survival, and overall survival.
Results Stent placement was successful in 24/25 patients (technical success: 96%). Clinical success was achieved in 23/25 (92%) patients. A mortality rate of 4% (1/25) was noted due to SVC rupture. Partial stent migration was noted in two patients (8%) and was treated by placing an additional overlapping stent. Incidental early stent thrombosis was seen in two patients within 8 hours of stent placement, but these patients showed symptom relief with anticoagulation. Follow-up imaging confirmed stent patency in all patients. Late stent occlusion due to tumor progression was seen in one patient. The primary patency rate was 88% (22/25). Overall median survival of 133 days was observed (range: 1–847 days).
Conclusion Endovascular stenting of the SVC for malignant obstruction using the body floss technique is associated with high technical and clinical success, and low rate of complications.
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Affiliation(s)
- Dayananda Lingegowda
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Bharat Gupta
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Anisha Gehani
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Priya Ghosh
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
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Ong DY, Quek LHH, Huang IKH, Lim GHT, Chan G, Wu YW, Ryu SW, Pua U. Single-Setting Superior Vena Cava Biopsy and Stenting Utilizing Cone Beam Computed Tomography as an Additional Tool. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929048. [PMID: 33750755 PMCID: PMC8006476 DOI: 10.12659/ajcr.929048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Malignant disease is a common etiology of superior vena cava syndrome (SVCS). Being a medical emergency, it often requires rapid diagnostic evaluation and therapy. Transcaval biopsy and endovascular stenting in a single-setting has been described, but only in a handful of cases. These cases utilized intra-operative venograms. In this study, we also used intra-operative cone beam computed tomography (CBCT) to increase the safety and efficacy of such single-setting procedures. CASE REPORT From January 2017 to July 2019, there were 5 patients with malignant SVCS who underwent single-setting superior vena cava biopsy and endovascular stenting utilizing intra-operative CBCT as an adjunct. Demographic data, clinical presentation, investigation results, procedural details, and patient outcomes were recorded. CBCT was utilized in all cases to optimize sampling of biopsies, visualize subsequent stent positioning, and for early detection of procedure-related complications. Transcaval biopsy was diagnostic in 4 of the 5 patients. Endovascular stents were deployed successfully in all cases, with post-stenting venogram demonstrating relief of prior obstructed segments. One patient had a complication of an apical pneumothorax, with no associated long-term pneumothorax-related morbidity or mortality. CONCLUSIONS This study demonstrates that single-setting transcaval biopsy and stenting in the context of malignant SVCS is a cost-efficient, safe, and feasible approach. In addition, the additional use of intra-operative CBCT is a useful tool to increase procedure efficacy and safety.
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Affiliation(s)
- Daniel Yuxuan Ong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Gavin Hock Tai Lim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gabriel Chan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yi-Wei Wu
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Seung Wook Ryu
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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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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Boily-Daoust C, Plante A, Adam C, Fortin M. Performance and safety of diagnostic procedures in superior vena cava syndrome. ERJ Open Res 2021; 7:00392-2020. [PMID: 33532462 PMCID: PMC7836491 DOI: 10.1183/23120541.00392-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Superior vena cava syndrome (SVCS) is an uncommon condition resulting from extrinsic compression or intraluminal blockade of the superior vena cava. The increased upper body venous pressure results in distended subcutaneous vessels and oedema of the head, neck and arms. SVCS can be a medical emergency if associated with laryngeal or cerebral oedema. The most common SVCS aetiologies are intrathoracic malignancies, accounting for 60 to 86% of cases [1–3]. Standard bronchoscopy and EBUS-TBNA have good diagnostic yield and are relatively safe procedures in the setting of SVCS. However, complications may arise from the underlying malignancy and its proximity to central vital structures.https://bit.ly/37HXFUY
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Affiliation(s)
- Catherine Boily-Daoust
- Dept of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Alexandre Plante
- Dept of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Cedrick Adam
- Dept of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Marc Fortin
- Dept of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
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44
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Lopez-Bauza A, Jara-Palomares L. Symptomatic Azygous Vein Thrombosis: Clinical Case and Literature Review. Arch Bronconeumol 2021; 57:S0300-2896(20)30559-7. [PMID: 33509623 DOI: 10.1016/j.arbres.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Angela Lopez-Bauza
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, España
| | - Luis Jara-Palomares
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, España; CIBERES, Instituto de Salud Carlos III, Madrid, España.
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45
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Nieves Condoy JF, Zúñiga Vázquez LA, Páez Hernández EM, Jiménez Herevia AE, Acuña Pinzon CL. Superior Vena Cava Syndrome Due to Thymic Carcinoma. Cureus 2020; 12:e11670. [PMID: 33391908 PMCID: PMC7769725 DOI: 10.7759/cureus.11670] [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] [Indexed: 11/09/2022] Open
Abstract
The superior vena cava syndrome (SVCS) is caused by a mechanical obstruction; 90% are of neoplasic etiology (lung cancer (LC) and non-Hodgkin lymphoma (NHL) mostly), epithelial neoplasms of the thymus (NET) is a rare cause, thymic carcinoma (TC) causing less than 1% of cases. A 56-year-old male presented with a four-month history of dyspnea, dysphonia, facial and cervical edema and bilateral cervical lymphadenopathy. The tomography showed bilateral, mediastinal, retroperitoneal lymphadenopathies, and obstruction of the internal jugular vein, right apical pulmonary nodules. A superficial adenopathy biopsy was taken, which is not conclusive, so it was decided to take an image-guided biopsy. During its evolution, it presents asymptomatic cardiovascular changes; in extension studies, systemic disease is evidenced. The definitive histopathological study reported thymic carcinoma. Systemic treatment with chemotherapy and radiation therapy was planned.
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46
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Morita S, Sugawara S, Suda T, Prasetyo D, Kobayashi Y, Hoshi T, Abe S, Yagi K, Terai S. Stent Placement for Malignant Inferior Vena Cava Syndrome in a Patient with Recurrent Colon Cancer. Intern Med 2020; 59:2885-2890. [PMID: 32727985 PMCID: PMC7725633 DOI: 10.2169/internalmedicine.5033-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 70-year-old man was admitted to our hospital with gait disturbance due to marked edema of the lower limbs for more than 6 months. He had been receiving systemic chemotherapy over two years for multiple recurrence after sigmoid colon cancer resection. Contrast-enhanced computed tomography demonstrated severe inferior vena cava (IVC) stenosis due to compression by lymph node metastases, i.e. IVC syndrome. As increased doses of diuretic agents failed to improve the edema, IVC stent placement was performed. This led to significant improvement of the edema and complete gait normalization. This case demonstrates the efficacy of IVC stent placement for IVC syndrome.
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Affiliation(s)
- Shinichi Morita
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Takeshi Suda
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Didik Prasetyo
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Yuka Kobayashi
- Department of Gastroenterology and Hepatology, Nagaoka Central General Hospital, Japan
| | - Takahiro Hoshi
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Satoshi Abe
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Kazuyoshi Yagi
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
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Matheus MV, Kowdley GC. Pemberton's Sign in a Patient With Multinodular Goiter. Am Surg 2020; 87:2003-2005. [PMID: 33136437 DOI: 10.1177/0003134820940289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Melissa V Matheus
- 2974 Department of Surgery, Saint Agnes Hospital, Ascension Health, Baltimore, MD, USA
| | - Gopal C Kowdley
- 2974 Department of Surgery, Saint Agnes Hospital, Ascension Health, Baltimore, MD, USA
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Matthaiou N, Galanakis N, Kehagias E, Kontopodis N, Charalambous S, Kholcheva N, Tsetis K, Mavroudis D, Tsetis D. Endovascular Treatment of Malignant Superior Vena Cava Syndrome through Upper-Limb Access: A Comparison between Venous-Dedicated and Conventional Stents. J Vasc Interv Radiol 2020; 31:2066-2072. [PMID: 33127247 DOI: 10.1016/j.jvir.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To retrospectively evaluate the technical and clinical outcomes of superior vena cava (SVC) stent placement through upper-limb venous access in malignant SVC syndrome (SVCS) and compare the efficacy of different nitinol stent types. MATERIALS AND METHODS Between 2006 and 2018, 156 patients (132 male; mean age, 62 y; age range, 33-81 y) underwent SVC stent placement for malignant obstructions through upper-limb venous access with 1 of 3 types of nitinol stent: 1 venous-dedicated (Sinus-XL stent) and 2 non-venous-dedicated (E-Luminexx Vascular Stent and Protégé GPS). Cases of common femoral vein access or non-nitinol stents were excluded from further analysis. The mean duration of follow-up was 8 mo. RESULTS Technical success was achieved in 99.3% of cases. One patient died during the procedure as a result of cardiac tamponade. Balloon predilation was performed in 10 patients and postdilation in 126. Mean procedural time was 34.4 min (range, 18-80 min). Overall survival rates were 92.3%, 57.3%, and 26.8%, and overall primary patency rates were 94.5%, 84.8% and 79.6%, at 1, 6, and 12 mo, respectively. There were no statistically significant differences in primary patency rates between venous- and non-venous-dedicated stents or among different Stanford SVCS grading groups (P > .05). CONCLUSIONS SVC stent placement through an upper-limb approach is a safe, fast, and effective technique. There is no evident benefit of venous-dedicated vs non-venous-dedicated stents in the treatment of malignant SVCS.
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Affiliation(s)
- Nikolas Matthaiou
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Stavros Charalambous
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Nelly Kholcheva
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Konstantinos Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece.
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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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50
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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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