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Lim Choi S, Il Gwon D, Ha Kim G, Won Kim S, Oh CH, Ko GY. Safety and efficacy of large-bore uncovered stents for treating malignant superior vena cava syndrome. Eur J Radiol 2024; 175:111446. [PMID: 38581861 DOI: 10.1016/j.ejrad.2024.111446] [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: 10/09/2023] [Revised: 03/04/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE To investigate the safety and efficacy of large-bore uncovered stents for treating malignant superior vena cava syndrome. METHODS This retrospective study included 115 patients (89 men, 26 women; mean age 63.2 years; range 21-83 years) who underwent endovascular large-bore (≥18 mm in diameter) uncovered stent placement between August 2015 and July 2022. One patient was lost to follow-up. Therefore, 114 patients were available for follow-up. RESULTS Stent placement was technically successful in all 115 patients. Minor procedure-related complications occurred in nine (7.8 %) patients. One hundred eight (93.9 %) patients experienced complete or marked symptomatic relief (Kishi score ≤ 2) at a mean of 3 days after procedure. The cumulative stent patency rates were 98.2 %, 95 %, 93.7 %, 91.5 %, 83.5 %, and 83.5 % at 1, 3, 6, 12, 18, and 24 months, respectively. Stent occlusion occurred in ten (8.8 %) of 114 patients at a mean of 215 days (range 1-732 days) due to thrombosis (n = 7) and tumor ingrowth (n = 3). Stent occlusion did not occur in 21 patients who underwent subsequent central venous catheter insertion. The median patient survival time was 159 days (95 % confidence interval 102-216 days). Univariate and multivariate Cox regression analysis revealed adjuvant anticancer treatment (p = 0.001) and tumor response (p < 0.001) as independent predictors of patient survival. CONCLUSIONS Endovascular placement of large-bore uncovered stents was a safe and effective treatment for malignant superior vena cava syndrome. Large-bore stent placement can effectively prevent stent occlusion by tumor ingrowth in most cases, and it can provide a sufficient diameter for subsequent insertion of central venous catheters.
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Affiliation(s)
- Sang Lim Choi
- Department of Radiology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Dong Il Gwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Gun Ha Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Won Kim
- Department of Radiology, Youngin Severance Hospital, Yonsei University College of Medicine, Youngin, Korea
| | - Chang Hoon Oh
- Department of Radiology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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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Léon D, Rao S, Huang S, Sheth R, Yevich S, Ahrar K, Huynh T, Pisimisis G, Kuban JD. Literature Review of Percutaneous Stenting for Palliative Treatment of Malignant Superior Vena Cava Syndrome (SVCS). Acad Radiol 2022; 29 Suppl 4:S110-S120. [PMID: 34602363 DOI: 10.1016/j.acra.2021.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the efficacy and safety of percutaneous stenting for the palliative treatment of malignant superior vena cava syndrome (SVCS). METHODS AND MATERIALS Literature review of retrospective studies was performed regarding direct procedural complications (fatal and non-fatal), clinical effectiveness, and patency rates (primary and secondary) of percutaneous transluminal stenting for the palliative treatment of malignant SVCS. Pooled rates and 95% confidence intervals were calculated for fatal complications, non-fatal complications, clinical effectiveness, primary patency, and secondary patency. Pooled rates were presented overall and by stent types (Wallstent, Nitinol stents, Steel stents and Stent Graft). Odds ratios and 95% confidence intervals were calculated to compare rates by stent type. RESULTS Overall fatal complications rate was 1.46%, 95% CI [0.91 -2.23], non-fatal complications rate was 8.28%, 95% CI [6.91 -9.83], clinical effectiveness was 90.50%, 95% CI [88.86 -91.97], primary patency rate was 86.18%, 95% CI [84.06-88.12], secondary patency rate was 94.05 %, 95% CI [91.82 -95.82]. Primary patency rate of the Wallstent group was 83.38%, 95% CI [79.34 -86.90], and significantly higher for the Nitinol group 94.87%, 95% CI [87.40 -98.60], OR = 3.67, p = 0.01, and for the Stent Graft group 96.10%, 95% CI [89.00 -99.20], OR = 4.92, p = 0.01. Secondary patency rate for the Wallstent group was 93.33%, 95% CI [88.87 -96.40] and significantly lower for the Steel group 77.42%, 95% CI [58.90 -90.41], OR = 0.25, p = 0.01. CONCLUSION Percutaneous stenting is a safe option for palliative treatment of patients with malignant SVCS with greater than 90% of patients experiencing immediate relief of symptoms, low rates of fatal complications (1.46%) and high patency rates (86.18% primary patency and 94.05% secondary patency).
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Aung EYS, Khan M, Williams N, Raja U, Hamady M. Endovascular Stenting in Superior Vena Cava Syndrome: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2022; 45:1236-1254. [PMID: 35821122 PMCID: PMC9458578 DOI: 10.1007/s00270-022-03178-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 05/15/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). METHODS MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper-Pearson estimation. RESULTS Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0-97.5%) and 92.8% (95% CI 91.7-93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0-93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). CONCLUSIONS This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. LEVEL OF EVIDENCE Level III, systematic review of retrospective cohort studies.
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Affiliation(s)
- Eri Yin-Soe Aung
- Imperial College School of Medicine, Imperial College London, Sir Alexander Fleming Building, Imperial College Road, London, SW72DD UK
| | - Maha Khan
- Imperial College School of Medicine, Imperial College London, Sir Alexander Fleming Building, Imperial College Road, London, SW72DD UK
| | - Norman Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, W1W 7JN UK
| | - Usman Raja
- Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
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Abstract
Background The objective of management of superior vena cava syndrome (SVCS) is to promptly alleviate the uncomfortable symptoms. Conventional approaches do not always achieve results as rapidly as endovascular management with stent placement. Objectives To report the experience with endovascular management of SVCS of a Vascular and Endovascular Surgery Service at a Brazilian university hospital. Methods Symptomatic type III SVCS cases were managed with angioplasty and stent placement in 28 patients aged from 37 to 68 years, between 2002 and 2012. The etiology of SVCS was lung or thoracic cancer in 18 patients, while occlusion of the vein for prolonged use of catheters was the cause in the other 10 cases. Results Superior vena cava occlusion repair was not possible in one oligosymptomatic patient with a very severe lesion. Technical success was achieved in 96.4%. There were two deaths, one due to pulmonary embolism, 24 hours after a successful procedure, and the other due to compression of the airways by tumor mass some hours after the procedure. Clinical success was achieved in all cases of technical success, including one patient who died suddenly, after total regression of SVCS symptoms. Symptoms disappeared 24 hours and 48 hours after management in16 and 8 patients respectively; improvement was slower but progressive after 48 hours in the remaining patients. Conclusions Endovascular stent placement was effective for management of SVCS, with good technical and clinical success rates and provided prompt relief from symptoms.
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Affiliation(s)
- Walter Kegham Karakhanian
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | - Walter Zavem Karakhanian
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | - Sergio Quilici Belczak
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Departamento de Cirurgia, Disciplina de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
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Abstract
Anticoagulation is often used in superior vena cava syndrome (SVCS) associated with cancer (i.e malignant SVCS), even without thrombosis, but its effect on outcomes has not been reported. We aimed to determine factors and outcomes associated with thrombosis and anticoagulation in malignant SVCS. Patients with malignant SVCS diagnosed on computerized tomography (CT) were retrospectively included, indexed at diagnosis and followed for 6 months using medical records. The cohort included 183 patients with malignant SVCS of which 153 (84%) were symptomatic. Thirty of the 127 patients (24%) with a reviewable baseline CT had thrombosis of the SVC or tributaries at diagnosis. Patients with baseline thrombosis more often had symptomatic SVCS (p < 0.01). 70% (21/30) of patients with thrombosis and 52% (49/97) of those without thrombosis at baseline received anticoagulation, most often at therapeutic doses. Thrombosis occurred in 5/39 patients with anticoagulation (13%) compared to 2/18 (11%) of those without, during follow-up (p = 0.85). Anticoagulation was associated with a reduction in risk of SVC stent placement during follow-up that did not reach statistical significance (HR 0.47, 95% CI 0.2-1.13, p = 0.09). Major bleeding occurred in 7 (4%) patients, six of whom received anticoagulation (four therapeutic and two intermediate dose). Neither thrombosis nor anticoagulation affected survival. Anticoagulation is commonly used as primary prevention but its benefit remains to be proven. The role of reduced-dose anticoagulation in non-thrombotic malignant SVCS should be prospectively assessed.
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Primary Stenting Is Not Necessary in Benign Central Venous Stenosis. Ann Vasc Surg 2017; 46:322-330. [PMID: 28807744 DOI: 10.1016/j.avsg.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/09/2017] [Accepted: 07/17/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study is to evaluate central venous stenosis (CVS) etiologies and presentation within a vascular surgery practice. We evaluated endovascular treatment modalities and the patency rates of our interventions. METHODS Five-year retrospective review of endovascular intervention for CVS. Patient demographics, medical comorbidities, and variables were collected including etiology, indwelling device, previous upper extremity (UE) deep venous thrombosis, long-term UE indwelling device (defined as >30 days), malignancy status, hypercoagulable disorders, history of radiation or mediastinal fibrosis or masses, and anticoagulation and/or antiplatelet therapy. Follow-up variables included symptoms, imaging, and anticoagulation and/or antiplatelet utilization. Living patients without recent follow-up were contacted with a telephone survey regarding current symptoms. Patency was evaluated by imaging or clinically by recurrence of signs or symptoms through January 2016. RESULTS A total of 61 patients underwent attempted endovascular CVS interventions from January 2007 to 2013. Forty-seven (83%) patients had successful interventions. There were 22 (36%) end-stage renal disease (ESRD) patients. The primary etiology in 79% of patients was benign CVS secondary to an indwelling device. Eighty-nine percent of the interventions were primary angioplasty (PTA). The overall primary patency rates at 6, 12, and 24 months were 49%, 34%, and 24%, respectively. Secondary patency rates at 6, 12, and 24 months were 97%, 93%, and 88%, respectively. There were no statistical differences in demographics or outcomes in patients treated successfully with PTA or those requiring stenting. There was no statistical difference in the patency rates between ESRD and non-ESRD patients. Previous interventions were not a predictor of loss of patency. CONCLUSIONS Our study supported the rising trend of benign CVS predominantly secondary to indwelling devices. We demonstrated acceptable secondary patency with PTA alone. This study adds further support for a primary angioplasty strategy in treating benign CVS. The optimal endovascular treatment for benign CVS is still undefined.
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Calsina Juscafresa L, Gil Bazo I, Grochowicz L, Páramo Alfaro M, López-Picazo González JM, Moreno Jiménez M, Bilbao Jaureguizar JI. Endovascular treatment of malignant superior vena cava syndrome secondary to lung cancer. Hosp Pract (1995) 2017; 45:70-75. [PMID: 28618844 DOI: 10.1080/21548331.2017.1342507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Superior Vena Cava obstruction results in severe oedema of the upper thorax. Endovascular treatment allows a rapid restoration of the blood flow with a rapid resolution of symptoms. We retrospectively report a single institution's experience in stent placement for malignant Superior Vena Cava Syndrome (SVCS) caused by lung cancer. METHODS Thirty-three consecutive patients (23 men, 10 women; median age, 57.6 years; range 34-71 years) who underwent endovascular SVCS palliative treatment were enrolled between August 2002 and June 2015. All patients presented SVCS secondary to lung cancer. Signs and symptoms of SVCS were scored. RESULTS All procedures were successfully completed (100% technical success rate). Twenty-eight patients showed a progressive clinical improvement after endovascular treatment of SVCS (84.8% clinical success rate) within 48 hours, there were five clinical failures which improved progressively with posterior radiotherapy. During follow-up, three patients (9%) suffered intra or post-procedural complications (1 cardiac arrhythmia, 2 stent thrombosis). CONCLUSIONS Stent placement in malignant SVCS seems to be an effective and rapid treatment for the relief of symptoms and quality of life improvement with a relatively low complications rate with a rapid resolution of symptoms. Therefore, it should be seriously considered as the first option in the SVC obstruction treatment.
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Affiliation(s)
| | | | - Lukasz Grochowicz
- a Vascular Surgery , Clínica Universidad de Navarra , Pamplona , Spain
| | - María Páramo Alfaro
- c Interventional Radiology , Clínica Universidad de Navarra , Pamplona , Spain
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Clark K, Chick JFB, Reddy SN, Shin BJ, Nadolski GJ, Clark TW, Trerotola SO. Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction. J Vasc Interv Radiol 2017; 28:602-607. [PMID: 28238580 DOI: 10.1016/j.jvir.2016.12.1222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction. MATERIALS AND METHODS CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance. RESULTS All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days). CONCLUSIONS Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.
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Affiliation(s)
- Katherine Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Shilpa N Reddy
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Radiology Associates of the Main Line, Main Line Health System, Bryn Mawr Hospital, Bryn Mawr, Pennsylvania
| | - Benjamin J Shin
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Timothy W Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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Mokry T, Bellemann N, Sommer CM, Heussel CP, Bozorgmehr F, Gnutzmann D, Kortes NA, Kauczor HU, Radeleff B, Stampfl U. Retrospective study in 23 patients of the self-expanding sinus-XL stent for treatment of malignant superior vena cava obstruction caused by non-small cell lung cancer. J Vasc Interv Radiol 2015; 26:357-65. [PMID: 25638748 DOI: 10.1016/j.jvir.2014.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/17/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate retrospectively the self-expanding nitinol Sinus-XL stent (OptiMed, Ettlingen, Germany) for the treatment of superior vena cava (SVC) obstruction caused by non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Between October 2009 and December 2012, 23 patients (7 women and 16 men; age, 62.5 y ± 8.5) with stage IIIA (1 patient), IIIB (4 patients) or IV (18 patients) NSCLC and acute SVC obstruction were scheduled for urgent stent implantation. The primary study endpoints were technical success (defined as accurate stent placement with complete coverage of the obstructed SVC), residual stenosis < 30%, and clinical efficacy. Complications were assessed as a secondary study endpoint. RESULTS There were 26 stents implanted in 23 patients. The technical success was 100%. Stent dilation was performed after deployment in 18 cases (78%). Stent migration into the right atrium occurred immediately after deployment in one patient; however, this stent was successfully repositioned and stabilized by a second stent. The clinical symptoms improved at least one category according to the International Consensus Committee on Chronic Venous Disease after stent implantation in all but one patient. The mean clinical follow-up was 66 days ± 83 (range, 1-305 d). Three minor complications (13%) and one major complication (4%) occurred. CONCLUSIONS Implantation of the self-expanding Sinus-XL stent for treatment of SVC obstruction caused by NSCLC is a safe and effective urgent treatment in this palliative setting.
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Affiliation(s)
- Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Nadine Bellemann
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Claus P Heussel
- Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxlinik University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Daniel Gnutzmann
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Nikolas A Kortes
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Hans U Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Ulrike Stampfl
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Abstract
Palliative care aims to optimize comfort and function when cure is not possible. Image-guided interventions for palliative treatment of lung cancer is aimed at local control of advanced disease in the affected lung, adjacent mediastinal structures, or distant metastatic sites. These procedures include endovascular therapy for superior vena cava syndrome, bronchial artery embolization for hemoptysis associated with lung cancer, and ablation of osseous metastasis. Pathophysiology, clinical presentation, indications of these palliative treatments, procedural techniques, complications, and possible future interventions are discussed in this article.
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Affiliation(s)
- Emi Masuda
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian - Weill Cornell Medical College, New York, New York
| | - Akhilesh K Sista
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian - Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian - Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian - Weill Cornell Medical College, New York, New York
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12
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Nasser F, Cavalcante RN, Galastri FL, Affonso BB. Use of transoesophageal echocardiography in endovascular stenting for superior vena cava syndrome. BMJ Case Rep 2013; 2013:bcr-2013-010356. [PMID: 23997077 DOI: 10.1136/bcr-2013-010356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Endovascular stenting is a recommended primary treatment for superior vena cava syndrome in patients with tumours. We describe a case where the vena cava stenosis was located 1 cm above the cavoatrial junction. In order to avoid malpositioning of the stent and its potential complications, such as arrhythmia or cardiac tamponade, transoesophageal echocardiography was used for guidance during the stent deployment.
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Affiliation(s)
- Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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13
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Lauten A, Strauch J, Jung C, Goebel B, Krizanic F, Baer FM. Endovascular Treatment of Superior Vena Cava Syndrome by Percutaneous Venoplasty. Heart Lung Circ 2010; 19:681-3. [DOI: 10.1016/j.hlc.2010.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 03/24/2010] [Accepted: 07/08/2010] [Indexed: 11/27/2022]
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Cho TH, Janho K, Mohan IV. The Role of Stenting the Superior Vena Cava Syndrome in Patients With Malignant Disease. Angiology 2010; 62:248-52. [DOI: 10.1177/0003319710382772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Superior vena cava (SVC) obstruction occurs in patients with intrathoracic malignancies. Clinical symptoms can be distressing but presentation is insidious. We investigated the outcome of endovascular management for patients with SVC syndrome. We retrospectively reviewed the case histories of 17 patients (9 men) from January 2003 to June 2009. All patients had malignant disease. There were 24 interventions (2 patients with 2 interventions and 2 patients with 3 interventions). All had SVC stenosis over 90%. All patients were treated with intrathoracic angioplasty and stenting. All procedures were technically successful, and all patients had insertion of 10 to 18 mm diameter stents with symptom resolution in 16 patients. There were 2 occlusions at 1 and 6 weeks and 2 patients with restenosis (3 and 7 months). Endovascular intervention is technically feasible for SVC occlusion, relieves symptoms, and is a useful palliation measure.
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Affiliation(s)
- Tae H. Cho
- University Department of Vascular Surgery, Westmead Hospital, Wentworthville, Sydney, Australia
| | - Kristi Janho
- University Department of Vascular Surgery, Westmead Hospital, Wentworthville, Sydney, Australia
| | - Irwin V. Mohan
- University Department of Vascular Surgery, Westmead Hospital, Wentworthville, Sydney, Australia,
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Merino Díaz B, Brizuela Sanz J, Mengíbar Fuentes L, Salvador Calvo R, González Fajardo J, Vaquero Puerta C. Tratamiento endovascular del síndrome de vena cava superior: nuestra experiencia clínica en la última década. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ganeshan A, Quen Hon L, Warakaulle DR, Morgan R, Uberoi R. Superior vena caval stenting for SVC obstruction: Current status. Eur J Radiol 2009; 71:343-9. [DOI: 10.1016/j.ejrad.2008.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 04/15/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
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Fatal Pericardial Tamponade After Superior Vena Cava Stenting. Cardiovasc Intervent Radiol 2008; 32:585-9. [DOI: 10.1007/s00270-008-9443-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Revised: 09/04/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
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Barshes NR, Annambhotla S, El Sayed HF, Huynh TT, Kougias P, Dardik A, Lin PH. Percutaneous stenting of superior vena cava syndrome: treatment outcome in patients with benign and malignant etiology. Vascular 2008; 15:314-21. [PMID: 17976332 DOI: 10.2310/6670.2007.00067] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Symptomatic obstruction of the superior vena cava (SVC) can be caused by either intrathoracic malignancy or nonmalignant etiology resulting in superior vena cava syndrome (SVCS). The objective of this study was to evaluate the clinical outcome of percutaneous stenting of SVCS in patients with malignant and benign disease. During a 9-year period, 56 patients with SVCS underwent percutaneous stenting placement. Among them, malignant and benign disease was responsible for 40 patients (71%) and 16 patients (29%), respectively. The Wallstent was the most commonly used stent and was used in 45 patients (80%), whereas the Palmaz stent was used in 6 patients (11%). In 38 patients (68%), a single stent was deployed to treat an SVC lesion. In contrast, bilateral kissing stents were deployed in 9 patients (16%), which extended from bilateral brachiocephalic veins to the proximal SVC. Technical success was achieved in all patients while symptomatic improvement was noted in 54 patients (96%). No procedural complications occurred in this series. Primary patency in malignant and benign cases at 1 year was 64% and 76%, respectively. Overall symptom-free survival ranged from 1 to 34 months. Our study showed that endovascular treatment with percutaneous stenting provides an effective treatment strategy in patients with SVCS caused by either malignant or benign disease.
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Affiliation(s)
- Neal R Barshes
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
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Kvale PA, Selecky PA, Prakash UBS. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:368S-403S. [PMID: 17873181 DOI: 10.1378/chest.07-1391] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED GOALS/OBJECTIVES: To review the scientific evidence on symptoms and specific complications that are associated with lung cancer, and the methods available to palliate those symptoms and complications. METHODS MEDLINE literature review (through March 2006) for all studies published in the English language, including case series and case reports, since 1966 using the following medical subject heading terms: bone metastases; brain metastases; cough; dyspnea; electrocautery; hemoptysis; interventional bronchoscopy; laser; pain management; pleural effusions; spinal cord metastases; superior vena cava syndrome; and tracheoesophageal fistula. RESULTS Pulmonary symptoms that may require palliation in patients who have lung cancer include those caused by the primary cancer itself (dyspnea, wheezing, cough, hemoptysis, chest pain), or locoregional metastases within the thorax (superior vena cava syndrome, tracheoesophageal fistula, pleural effusions, ribs, and pleura). Respiratory symptoms can also result from complications of lung cancer treatment or from comorbid conditions. Constitutional symptoms are common and require attention and care. Symptoms referable to distant extrathoracic metastases to bone, brain, spinal cord, and liver pose additional problems that require a specific response for optimal symptom control. There are excellent scientific data regarding the management of many of these issues, with lesser evidence from case series or expert opinion on other aspects of providing palliative care for lung cancer patients. CONCLUSIONS Palliation of symptoms and complications in lung cancer patients is possible, and physicians who provide such care must be knowledgeable about these issues.
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Affiliation(s)
- Paul A Kvale
- Division of Pulmonary, Critical Care, Allergy, Immunology, and Sleep Disorders Medicine, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA.
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Bakir I, La Meir M, Degrieck I, Marien C, Van den Hauwe K, Wellens F. Contralateral Replacement of Pacemaker and Leads Following Laser Sheath Extraction and Concomitant Stenting for Superior Vena Cava Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:1131-4. [PMID: 16221275 DOI: 10.1111/j.1540-8159.2005.00226.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present the case of a 61-year-old man with a history of pacemaker implantation 15 years ago. The patient was admitted with chronic swelling of the right hemithorax and inflammation of the old incision scar after the replacement of pacemaker generator 6 years ago. The patient also presented symptoms and clinical signs of superior vena cava syndrome. Computed tomography of the thorax showed obstruction of the superior vena cava. The surgical procedure consisted of extraction of infected pacemaker system with excimer laser technique followed by dilatation and stenting of the SVC and finally implantation of a new permanent pacemaker system on the left side.
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Affiliation(s)
- Ihsan Bakir
- Department of Thoracic and Cardiovascular Surgery, OLV Hospital, Aalst, Belgium.
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