1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
2
|
Adi O, Apoo FN, Fong CP, Ahmad AH, Panebianco N. Hypotensive patient with superior vena cava obstruction diagnosed using resuscitative transesophageal echocardiography. Am J Emerg Med 2023; 72:224.e1-224.e4. [PMID: 37500381 DOI: 10.1016/j.ajem.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Superior vena cava syndrome (SVCS) is a malignancy-related emergency. It is caused by obstruction of blood flow in the superior vena cava (SVC) secondary to intraluminal thrombosis, external compression, or direct invasion of tumor. CASE SUMMARY A 49-year-old male presented to the emergency department (ED) with acute hypoxemic respiratory failure. He was intubated and treated as pneumonia. Post-intubation, he became hypotensive, requiring fluid resuscitation and inotropic support. Resuscitative transesophageal echocardiography (TEE) showed external compression by a lung mass and an intraluminal thrombus causing SVC obstruction. Computed tomography (CT) angiography was performed, and it confirmed the TEE findings. A provisional diagnosis of lung carcinoma was made, and he underwent endovascular therapy for rapid symptomatic relief. DISCUSSION This case report highlights the role of resuscitative TEE in evaluating a hypotensive patient with clinical suspicion of SVCS at the emergency department. TEE performed at the bedside could help to diagnose and demonstrate the pathology causing SVCS in this case. TEE allowed high-quality image acquisition and was able to overcome the limitation of transthoracic echocardiography (TTE). TEE should be considered as an alternative ED imaging modality in the management of SVCS. LEARNING POINTS
Collapse
Affiliation(s)
- Osman Adi
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Farah Nuradhwa Apoo
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Chan Pei Fong
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Azma Haryaty Ahmad
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Nova Panebianco
- Emergency Medicine, Division of Emergency Ultrasound, Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America.
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
4
|
Sheng CC, Wilkoff BL, Lyden SP, Soltesz E, Cameron SJ, Nanjundappa A. Images in Vascular Medicine: Valsalva purpura secondary to balloon occlusion of the cavoatrial junction during intervention for lead-induced SVC syndrome. Vasc Med 2023; 28:479-480. [PMID: 37650456 DOI: 10.1177/1358863x231191902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Calvin C Sheng
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sean P Lyden
- Department of Vascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott J Cameron
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
5
|
Wong HCY, Chan AW, David E, Marta GN, Pan NY, Koller M, Lim F, Yeung R, Chow E, Simone CB. Should endovascular stenting be used routinely as first-line treatment for malignant superior vena cava syndrome?-a critical review in the context of recent advances in oncological treatments. Ann Palliat Med 2023; 12:803-815. [PMID: 37038079 DOI: 10.21037/apm-22-1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
Malignant superior vena cava syndrome (SVCS) is no longer considered a medical emergency in most cases because it rarely leads to life-threatening complications. However, it results in disturbing symptoms that can significantly affect patients' quality of life. Treating this condition effectively while minimising treatment-related morbidity is of increasing importance as cancer patients are living longer from advances in oncological treatments. This clinical practice review discusses the implications of these advances on the decision to consider stenting as the initial treatment for SVCS. Stenting is increasingly popular as it provides quick symptomatic relief with low rates of complications. Systemic treatments have evolved in the past two decades with the development of immunotherapy and targeted therapies that have different response patterns compared to conventional chemotherapy. Furthermore, major changes have also been seen in radiotherapy techniques that allow treatments to better conform to targets while sparing normal tissues. These advances have changed practice patterns for stent placement in SVCS patients in both the localised and metastatic settings. Prospective studies using standardised patient-reported outcome tools are needed to determine the optimal treatment sequence for SVCS patients, as current recommendations are mainly based on retrospective single-arm studies. An individualized approach with multidisciplinary input is therefore important to optimize patient outcomes before more robust evidence is available.
Collapse
Affiliation(s)
- Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Elizabeth David
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Nin Yuan Pan
- Department of Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Michael Koller
- University Hospital Regensburg, Center for Clinical Studies, Regensburg, Germany
| | - Fiona Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Rebecca Yeung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| |
Collapse
|
6
|
Dabo-Trubelja A. Challenging conventional Superior Vena Cava (SVC) syndrome treatment. Ann Palliat Med 2023; 12:662-664. [PMID: 37038069 DOI: 10.21037/apm-22-1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Anahita Dabo-Trubelja
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY, USA
| |
Collapse
|
7
|
Yang QS, Han YL, Cai JY, Gu S, Bai J, Ren H, Xu M, Zhang J, Zhang AA, Su M, Pan C, Wang Y, Tang JY, Gao YJ. [Analysis of 42 cases of childhood superior vena cava syndrome associated with mediastinal malignancy]. Zhonghua Er Ke Za Zhi 2022; 60:1026-1030. [PMID: 36207849 DOI: 10.3760/cma.j.cn112140-20220323-00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To summarize the clinical features, management and outcome of superior vena cava syndrome (SVCS) associated with mediastinal malignancy in children. Methods: Clinical data of 42 children of SVSC associated with mediastinal malignancy in Shanghai Children's Medical Center from January 2015 to December 2021 were collected and analyzed retrospectively. The clinical manifestations, pathological diagnosis, disease diagnosis process, and prognosis were summarized. Results: Among 42 children of SVCS associated with mediastinal malignancy, there were 31 males and 11 females. The age at diagnosis was 8.5 (1.9, 14.9) years. Cough and wheezing (33 cases, 79%), orthopnea (19 cases, 45%) and facial edema (18 cases, 43%) occurred most commonly. T-cell lymphoblastic lymphoma (T-LBL) was the most frequent pathological diagnosis (25 cases, 60%), followed by T-cell acute lymphoblastic leukemia (T-ALL) (7 cases, 17%), anaplastic large cell lymphoma (4 cases, 10%) and diffuse large B-cell lymphoma (2 cases, 5%), peripheral T-lymphoma, Hodgkin lymphoma, Ewing's sarcoma and germ cell tumor (1 case each). Pathological diagnosis was confirmed by bone marrow aspiration or thoracentesis in 14 cases, peripheral lymph node biopsy in 6 cases, and mediastinal biopsy in 22 cases. Twenty-seven cases (64%) had local anesthesia. Respiratory complications due to mediastinal mass developed in 3 of 15 cases who received general anesthesia. Of the 42 cases, 27 cases had sustained remission, 1 case survived with second-line therapy after recurrence, and 14 cases died (2 cases died of perioperative complications and 12 cases died of recurrence or progression of primary disease). The follow-up time was 36.7 (1.2, 76.1) months for 27 cases in continuous complete remission. The 3-year overall survival (OS) and events free survival (EFS) rates of 42 children were 59% (95%CI 44%-79%) and 58% (95%CI 44%-77%) respectively. Conclusions: SVCS associated with mediastinal malignancy in children is a life-threatening tumor emergency with high mortality. The most common primary disease is T-LBL. The most common clinical symptoms and signs are cough, wheezing, orthopnea and facial edema. Clinical management should be based on the premise of stable critical condition and confirm the pathological diagnosis through minimal invasive operation.
Collapse
Affiliation(s)
- Q S Yang
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Y L Han
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - J Y Cai
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - S Gu
- Department of General Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - J Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - H Ren
- Department of Critical Care Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - M Xu
- Department of General Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - J Zhang
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - A A Zhang
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - M Su
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - C Pan
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Y Wang
- Department of Critical Care Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - J Y Tang
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Y J Gao
- Department of Hematology/Oncology,Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| |
Collapse
|
8
|
Subspecialty Group of Oncology, the Society of Pediatrics, Chinese Medical Association, Subspecialty Group of Hematology, the Society of Pediatrics, Chinese Medical Association, Children′s Cancer Group, Chinese Anti-Cancer Association, Editorial Board, Chinese Journal of Pediatrics. [Expert consensus on management of childhood superior vena cava syndrome associated with mediastinal malignancy]. Zhonghua Er Ke Za Zhi 2022; 60:979-82. [PMID: 36207842 DOI: 10.3760/cma.j.cn112140-20220524-00478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
|
9
|
Duan YL, Wang TY. [Improve the management of childhood superior vena cava syndrome associated with mediastinal malignancy by strengthening multidisciplinary cooperation]. Zhonghua Er Ke Za Zhi 2022; 60:970-972. [PMID: 36207840 DOI: 10.3760/cma.j.cn112140-20220818-00737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Y L Duan
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - T Y Wang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| |
Collapse
|
10
|
Silva N, Veloso Gomes F, Coelho JS, Bilhim T. Changes of the hepatic subcapsular blood flow in a case of high-grade retroperitoneal liposarcoma: what to expect? BMJ Case Rep 2021; 14:14/1/e237317. [PMID: 33431536 PMCID: PMC7802678 DOI: 10.1136/bcr-2020-237317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Changes of the hepatic subcapsular blood flow with the early appearance of hypervascularity near the falciform ligament are rare radiologic findings. They present most frequently in cases of superior vena cava (SVC) obstruction and are related to the recruitment of the cavo-mammary-phrenic-hepatic-capsule-portal and the cavo-superficial-umbilical-portal pathways. We present the case of a 52-year-old female patient with an highly aggressive retroperitoneal liposarcoma with SVC obstruction caused by external compression due to a mediastinal metastatic mass. The patient exhibited no symptoms of SVC obstruction due to the collateral cavo-portal pathways.
Collapse
Affiliation(s)
- Nádia Silva
- Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | | | | | - Tiago Bilhim
- Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| |
Collapse
|
11
|
Abstract
Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Education of the patient and family may help empower them to adequately handle many situations when clinicians are not available.
Collapse
Affiliation(s)
- Benjamin M Skoch
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Christian T Sinclair
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA. https://twitter.com/ctsinclair
| |
Collapse
|
12
|
Nossair F, Schoettler P, Starr J, Chan AKC, Kirov I, Paes B, Mahajerin A. Pediatric superior vena cava syndrome: An evidence-based systematic review of the literature. Pediatr Blood Cancer 2018; 65:e27225. [PMID: 29781569 DOI: 10.1002/pbc.27225] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
Superior vena cava syndrome (SVCS) results in vascular, respiratory, and neurologic compromise. A systematic search was conducted to determine the prevalence of pediatric SVCS subtypes and identify clinical characteristics/treatment strategies that may influence overall outcomes. Data from 101 case reports/case series (142 patients) were analyzed. Morbidity (30%), mortality (18%), and acute complications (55%) were assessed as outcomes. Thrombosis was present in 36%, with multi-modal anticoagulation showing improved outcome by >50% (P = 0.004). Infant age (P = 0.04), lack of collaterals (P = 0.007), acute complications (P = 0.005), and clinical presentation may have prognostic utility that could influence clinical decisions and surveillance practices in pediatric SVCS.
Collapse
Affiliation(s)
- Fadi Nossair
- Division of Oncology, CHOC Children's, Orange, California
- Division of Hematology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Peter Schoettler
- Department of Pediatrics, University of California-Irvine, Irvine, California
- Department of Pediatrics, CHOC Children's, Orange, California
| | - Joanne Starr
- Division of Cardiothoracic Surgery, CHOC Children's, Orange, California
| | - Anthony K C Chan
- Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ivan Kirov
- Division of Oncology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Arash Mahajerin
- Division of Hematology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| |
Collapse
|
13
|
Kuo TT, Chen PL, Shih CC, Chen IM. Endovascular stenting for end-stage lung cancer patients with superior vena cava syndrome post first-line treatments - A single-center experience and literature review. J Chin Med Assoc 2017; 80:482-486. [PMID: 28501315 DOI: 10.1016/j.jcma.2017.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Superior vena cava (SVC) syndrome is a major complication that occurs when a growing lung malignancy compresses the SVC extrinsically. Current treatment options include radiotherapy or chemotherapy to shrink the tumor or endovascular stenting of the SVC to restore flow. Herein, we report a case series treated in a single institution to demonstrate the safety, effectiveness, and outcomes of salvage and primary stenting for malignant SVC obstruction. METHODS A total of 12 male patients with malignant superior vena cava obstruction caused by lung cancer underwent SVC stenting from October 2009 to May 2015. Data were reviewed retrospectively, including demographic and clinical characteristics, procedural details, and outcomes. RESULTS Seven patients had received radiotherapy prior to SVC stenting, while the other five patients received stenting as first-line therapy for SVC syndrome. Only one patient experienced initial symptomatic improvement after radiotherapy, and symptoms of SVC syndrome recurred one year later. Wallstents® (Boston Scientific, Natick MA, USA) were used in all patients. Preoperatively, the mean narrowest SVC diameter measured by CT was 2.16 mm (0-5.5 mm). Technical success was achieved in all patients without complications such as pulmonary embolism, rupture or bleeding. Postoperative mean narrowest SVC diameter measured by CT during follow-up was 11.17 mm (8-13.5 mm). Symptoms of SVC syndrome such as arm and face swelling and dyspnea improved within 1-5 days in all patients. After median follow-up duration of 11.5 months, only one patient presented recurrent SVC syndrome due to in-stent thrombosis two months after stenting. CONCLUSION Salvage SVC stenting remains a safe and effective treatment for patients with SVC obstruction after failure of radiotherapy and chemotherapy. Primary stenting may be considered at initial presentation of SVC syndrome to improve patients' quality of life.
Collapse
Affiliation(s)
- Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, ROC
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, ROC.
| |
Collapse
|
14
|
McLenon M, Bittle GJ, Jones K, Menaker J, Pham SM, Iacono AT, Sachdeva A, Rajagopal K. Extracorporeal Lung Support as a Bridge to Airway Stenting and Radiotherapy for Airway-Obstructing Pancoast Tumor. Ann Thorac Surg 2017; 102:e7-9. [PMID: 27343540 DOI: 10.1016/j.athoracsur.2015.10.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/19/2015] [Accepted: 10/26/2015] [Indexed: 12/20/2022]
Abstract
Venovenous (V-V) extracorporeal membrane oxygenation (ECMO) is used for respiratory failure that is suspected to be reversible (bridge to recovery), or as a bridge to lung transplantation. Patients with proximal airway obstruction due to endobronchial malignancy can develop acute respiratory failure, and may benefit from V-V ECMO as a bridge to airway intervention, further treatment, and eventual recovery. We describe a case of a superior sulcus tumor with tracheobronchial and superior vena cava invasion causing both respiratory failure and superior vena cava syndrome. This was treated successfully with V-V ECMO, bronchial stenting, and radiotherapy.
Collapse
Affiliation(s)
- Melissa McLenon
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine and Medical Center, Baltimore, Maryland
| | - Gregory J Bittle
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine and Medical Center, Baltimore, Maryland
| | - Kevin Jones
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine and Medical Center, Baltimore, Maryland
| | - Jay Menaker
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine and Medical Center, Baltimore, Maryland
| | - Si M Pham
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine and Medical Center, Baltimore, Maryland
| | - Aldo T Iacono
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine and Medical Center, Baltimore, Maryland
| | - Ashutosh Sachdeva
- Division of Pulmonary/Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine and Medical Center, Baltimore, Maryland
| | - Keshava Rajagopal
- Center for Advanced Heart Failure and Department of Cardiovascular Surgery, University of Texas-Houston and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.
| |
Collapse
|
15
|
Shatila W, Almanfi A, Massumi M, Dougherty KG, Parekh DR, Strickman NE. Endovascular Treatment of Superior Vena Cava Syndrome via Balloon-in-Balloon Catheter Technique with a Palmaz Stent. Tex Heart Inst J 2016; 43:520-523. [PMID: 28100973 DOI: 10.14503/thij-15-5479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Superior vena cava syndrome is a well-known disease entity that carries substantial rates of morbidity and mortality. Although most cases of superior vena cava syndrome are secondary to a malignant process, additional causes (such as mediastinal fibrosis, pacemaker lead implantation, or central venous catheter placement) have been reported. Multiple treatment options include percutaneous transluminal angioplasty, stent implantation, thrombolysis, mechanical thrombectomy, and venous grafting. We present a case of superior vena cava syndrome in a symptomatic 30-year-old woman who obtained complete relief of obstruction and marked symptomatic improvement through venoplasty and stenting, aided by our use of a balloon-in-balloon catheter system.
Collapse
|
16
|
Oshima K, Takahashi T, Ishikawa S, Nagashima T, Hirai K, Morishita Y. Superior Vena Cava Rupture Caused During Balloon Dilation for Treatment of SVC Syndrome Due to Repetitive Catheter Ablation. Angiology 2016; 57:247-9. [PMID: 16518536 DOI: 10.1177/000331970605700218] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 29-year-old woman with an implanted AAI mode permanent pacemaker, who had undergone catheter ablation for inappropriate sinus tachycardia 4 times, experienced complications of superior vena cava (SVC) syndrome. Severe stenosis of the SVC wall was observed in computed tomograms. During balloon dilation for the treatment of SVC syndrome, the SVC was ruptured, resulting in cardiac tamponade. An emergency operation was performed using percutaneous cardiopulmonary support (PCPS). A longitudinal tear 1 cm in length was identified at the junction of the right atrium and the SVC, requiring a patch plasty using an autologous pericardium 2.5 cm x 3 cm in size. SVC rupture is a complication to be completely avoided when we perform balloon dilation for the treatment of SVC syndrome. Therefore, the indication of balloon dilation for the treatment of SVC syndrome requires critical examination and attention.
Collapse
Affiliation(s)
- Kiyohiro Oshima
- Second Department of Surgery, Gunma University Faculty of Medicine, Gunma, Japan.
| | | | | | | | | | | |
Collapse
|
17
|
Dinkel HP, Mettke B, Schmid F, Baumgartner I, Triller J, Do DD. Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Is Bilateral Wallstent Placement Superior to Unilateral Placement? J Endovasc Ther 2016; 10:788-97. [PMID: 14533962 DOI: 10.1177/152660280301000416] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report our experience with unilateral versus bilateral stent placement in the treatment of malignant superior vena cava syndrome (SVCS). Methods: The records and films of 84 consecutive patients (69 men; mean age 64±10 years, range 39–79) referred for stent placement in malignant SVCS were reviewed for venous compromise, technical and clinical success, complications, and reocclusions. Wallstents were placed covering the SVC and both (bilateral technique) brachiocephalic veins (BCV) preferentially; unilateral stenting of only one BCV in addition to the SVC was performed based on operator preference or inability to access both sides. Technical success was defined as the ability to stent the SVC and at least one BCV; clinical success was the elimination of SVCS symptoms. Results: Technical success was achieved in 83 (99%) patients, using the unilateral technique in 22 and bilateral stenting in 61 patients. The groups did not differ with regard to age, sex, underlying diseases, or location and extent of venous compromise. Immediate clinical success was achieved in 20 (91%) of 22 patients in the unilateral group and 55 (90%) of 61 patients in the bilateral group. Two patients suffered late occlusion in the unilateral group, while in the bilateral group, 8 patients had early occlusion and 9 had late occlusion. Thus, the total occlusion rate was significantly (p<0.05) lower in the unilateral group. There was 1 other complication (pericardial tamponade) in the bilateral group, for a 28% total complication rate, which was significantly higher (p = 0.039) than the 9% in the unilateral group. The 1, 3, 6, and 12-month primary stent patency rates were 90%, 81%, 76%, and 69%, respectively. Patency tended to last longer in the unilateral group, but the difference was not significant (p = 0.11). Conclusions: Although bilateral Wallstent placement achieved equal technical and clinical success, it tended to confer shorter-lived patency and caused more complications.
Collapse
Affiliation(s)
- Hans-Peter Dinkel
- Department of Diagnostic Radiology, Inselspital, University Hospital of Berne, Switzerland.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
Authors are unable to update this review. New authors are being sought to update it. The editorial group responsible for this previously published document have withdrawn it from publication.
Collapse
Affiliation(s)
- Nick P Rowell
- Maidstone HospitalKent Oncology CentreHermitage LaneMaidstoneKentUKME16 9QQ
| | - Fergus V Gleeson
- Churchill HospitalDepartment of Clinical RadiologyOld RoadHeadingtonOxfordUKOX3 7LJ
| | | |
Collapse
|
19
|
Song J, McDermott VM, Ryan P, Bird BRH. Myxofibrosarcoma directly invading superior vena cava causing obstruction successfully relieved by endovascular stent. Acta Oncol 2015; 54:141-3. [PMID: 25365347 DOI: 10.3109/0284186x.2014.953261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jiheon Song
- School of Medicine, University College Cork , Cork , Ireland
| | | | | | | |
Collapse
|
20
|
Mujtaba M, Siddiqi SA, Sadiq I, Spillane RM. Disintegration with right ventricular and pulmonary embolization of a SMART stent: a case report and review of literature. Conn Med 2014; 78:521-524. [PMID: 25675590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As composition and design have improved the integrity and durability of peripheral stents, vascular stent fracture and embolization have become less frequent complications of endovascular intervention. However, this phenomenon still remains a possibility with potentially catastrophic consequences, either from damage to cardiac structures or from disruption of vessel integrity, infarction, and thrombosis. Advancements in the tools for foreign body retrieval have allowed the skilled interventionalist to intercede without the need for surgical intervention. We report the case of retrieval of a self-expandable SMART (Cordis, Florida) stent that was deployed for relief of superior vena cava syndrome but fractured and embolized to the right ventricle.
Collapse
|
21
|
|
22
|
Marciniak A, Gonsalves M, Gallagher MM. Superior vena cava syndrome after radiofrequency sinus node modification treated with thrombolysis and stent implantation. Europace 2014; 17:37. [PMID: 25001544 DOI: 10.1093/europace/euu021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Marciniak
- Departments of Cardiology and Radiology, St. George's Hospital, London SW17 0QT, UK
| | - M Gonsalves
- Departments of Cardiology and Radiology, St. George's Hospital, London SW17 0QT, UK
| | - M M Gallagher
- Departments of Cardiology and Radiology, St. George's Hospital, London SW17 0QT, UK
| |
Collapse
|
23
|
Tempelhof M, Campbell J, Ilkhanoff L. Sinus arrest following angioplasty and stenting for superior vena cava syndrome. J Invasive Cardiol 2014; 26:E21-E23. [PMID: 24486673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Superior vena cava (SVC) syndrome is a complication resulting from long-term residence of leads or in-dwelling catheters at the SVC to right atrial (RA) junction. SVC syndrome management is complicated by variable responses to anticoagulation therapies and technically challenging interventional procedures, such as balloon dilatation or stent placement at the SVC-RA junction to relieve blood-flow obstruction. Potential complications resulting from angioplasty/stenting for SVC syndrome are serious and include stent migration, major bleeding, and embolism. Bradyarrhythmias have not been reported. We describe a case of balloon angioplasty and stenting for SVC syndrome in a dialysis patient that resulted in sinus arrest. The complication developed within hours of angioplasty/stenting of her chronic, non-thrombotic SVC obstruction. We highlight the management approach to this patient and discuss potential mechanisms underlying the complication.
Collapse
Affiliation(s)
- Michael Tempelhof
- Northwestern University, 251 East Huron Street, Feinberg 08-503, Chicago, IL 60611 USA.
| | | | | |
Collapse
|
24
|
Bochenek-Cibor J, Püsküllüoğlu M, Zygulska A. Oncological emergencies: superior vena cava syndrome. Przegl Lek 2014; 71:697-699. [PMID: 25951699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Superior vena cava obstruction leads to the venous hypertension of the head, neck, upper extremities and upper part of the truncus. Its clinical manifestation, known as the superior vena cava syndrome, is a complication of malignancy, mainly of lung cancer and lymphoma. As it usually affects patients with advanced disease, the prognosis is poor. This article stresses the importance of early detection and adequate management of this onco- logical emergency. The diagnostic tools as well as treatment possibilities are discussed.
Collapse
|
25
|
Bosma JW, Veenstra J, Vasmel WLE. [Patients with superior vena cava syndrome: pitfalls in recognition]. Ned Tijdschr Geneeskd 2014; 158:A6858. [PMID: 24397971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Superior vena cava syndrome (SVCS) may be the presenting sign of malignancy. SVCS may be difficult to recognize due to its usual slow development or possible temporary regression. We discuss the pitfalls in recognizing SVCS by presenting two cases. In a 45-year-old man, facial swelling diminished after he was administered intraarticular steroids to treat brachialgia. During the same period, collateral veins appeared on his chest wall. Only a few weeks later he was diagnosed with SVCS due to lung cancer. A 31-year-old man with a swollen face was treated with glucocorticoids, allegedly for an allergic reaction. When symptoms recurred after one week, it was discovered that SVCS was caused by lymphoma. These cases illustrate that the first manifestations of SVCS may be subtle and that development of collaterals or the use of glucocorticoids may relieve symptoms. Importantly, late diagnosis of SVCS results in delay of treatment of the underlying cause, which is often malignant.
Collapse
Affiliation(s)
- Jacob W Bosma
- Sint Lucas Andreas Ziekenhuis, afd. Interne Geneeskunde, Amsterdam
| | | | | |
Collapse
|
26
|
Luo J, Chen B, Jiang S, Zhou SW. [Interventional therapy for lung cancer patients with superior vena cava syndrome]. Zhonghua Zhong Liu Za Zhi 2013; 35:627-631. [PMID: 24314224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the method, therapeutic effect and safety of interventional therapy for lung cancer patients with superior vena cava syndrome (SVCS). METHODS Fifty-two cases of lung cancer with SVCS who received interventional therapy in our hospital between Jan to Dec 2011 were included in this study. Of the 52 cases, 50 cases had successfully carried out superior vena cava stent implantation. The distal venous pressure was measured before and after angioplasty, and the results were assessed by Wilcoxon matched-pairs test. In addition, the 50 patients were followed up and the therapeutic effect and postoperative survival rate were evaluated. RESULTS The mean distal venous pressure in the 50 patients was significantly decreased from preoperative (28.2 ± 1.9)cm H2O to postoperative (8.7 ± 0.5)cm H2O (P = 0.0085). The efficacy of the treatment was as follows: complete remission (20/52, 38.5%), partial remission (28/52, 53.8%), ineffective 4 (4/52, 7.7%), and total effective rate 92.3%. The complications after angioplasty and stent implantation included chest pain (12 cases, 23.1%), hematoma at the puncture site (5 cases, 9.6%), and fever (2 cases, 3.8%). No serious complications such as massive hemorrhage, pulmonary embolism and stent migration into the cardiac atrium were observed. The rate of postoperative restenosis was low (2/52, 3.8%). For the SCLC group, the objective effective rate was 74.1% and 1-year survival rate was 21.0%. For the NSCLC group, the objective effective rate was 21.7% and 1-year survival rate was 35.0%. CONCLUSIONS For lung cancer patients with SVCS, interventional therapy may relief obstruction effectively, promote blood flow recovery, and relieve clinical symptoms. Interventional therapy with endovascular angioplasty and stenting may be highly recommended as the first choice for palliative treatment of SVCS. It is an effective initial palliative treatment. However, subsequent comprehensive anti-tumor treatment is necessary.
Collapse
Affiliation(s)
- Jie Luo
- Department of Oncology, Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | | | | | | |
Collapse
|
27
|
Espitia O, Guerin P, Néel A, Espitia-Thibault A, Pottier P, Planchon B, Pistorius MA. [Superior vena cava syndrome induced by pacemaker probes, 12 years after introduction]. J Mal Vasc 2013; 38:193-197. [PMID: 23433510 DOI: 10.1016/j.jmv.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 12/31/2012] [Indexed: 06/01/2023]
Abstract
Superior vena cava syndrome is a rare disease, most often found to result from a malignant process, which causes extrinsic compression of the superior vena cava. In recent years, there has been an increase of superior vena cava syndrome related to medical devices (implantable site, pacemaker [PM], central venous line for parenteral nutrition...). We report the case of a 37-year-old patient who developed a superior vena cava syndrome 12 years after implantation of a PM. The diagnosis was established on venography after two negative venous-CT focused on the superior vena cava. The superior vena cava syndrome improved immediately after angioplasty and stenting covering the PM probes at the superior vena cava/brachiocephalic venous trunk junction.
Collapse
Affiliation(s)
- O Espitia
- Service de Médecine Interne, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Superior Vena Cava Syndrome (SVCS) refers to signs and symptoms caused by obstruction of the superior vena cava. Superior mediastinal syndrome (SMS) is the term used when SVCS coexists with obstruction of trachea. In children, a mediastinal pathology causing SVCS generally results in SMS as well, due to the limited chest volume. Hence, the two terms are often used interchangeably in children. SMS is a medical emergency that can be challenging, albeit often rewarding to manage. The common causes in a patient presenting to pediatric emergency room include non-Hodgkin lymphoma and acute lymphoblastic leukemia. Patients with SMS are at a very high risk for adverse cardio-respiratory events in case they are administered any kind of anesthetic agents, anxiolytics or sedatives. Investigations, including tissue diagnosis are desirable, though not mandatory, before initiating emergency management. The patient's clinical condition should dictate the speed, requirement and sequence of investigations and the specific treatment. The least invasive procedure should be performed to confirm the diagnosis. As the most common cause of SMS in children is lymphoma/leukemia, the administration of systemic steroids is often the front line therapy. Diagnosis, monitoring and management of SMS in relevance to the pediatric emergency room are outlined.
Collapse
Affiliation(s)
- Richa Jain
- Department of Pediatrics, Pediatric Hematology Oncology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | | | | | | |
Collapse
|
29
|
Dziekiewicz M, Kade G, Wańkowicz Z, Maruszyński M. [Endovascular management of superior vena cava syndrome prior to arterio-venous fistula creation in patient treated by repeated haemodialysis]. Kardiol Pol 2013; 71:105. [PMID: 23348549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 01/22/2013] [Indexed: 06/01/2023]
Affiliation(s)
- Mirosław Dziekiewicz
- Klinika Chirurgii Naczyniowej i Endowaskularnej, Wojskowy Instytut Medyczny, Warsaw.
| | | | | | | |
Collapse
|
30
|
Phillips PM, Mallette AC, Aru GM, Mitchell ME. The treatment of superior vena cava syndrome secondary to idiopathic fibrosing mediastinitis with balloon angioplasty and stenting. Am Surg 2012; 78:1405-1406. [PMID: 23265133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Paul M Phillips
- Department of Surgery, Divisions of Thoracic and Vascular/Endovascular Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | | | | | | |
Collapse
|
31
|
Laurent G, Ricolfi F, Wolf JÉ. Venous stenting as a treatment for pacemaker-induced superior vena cava syndrome. Arch Cardiovasc Dis 2012; 106:624-6. [PMID: 23791590 DOI: 10.1016/j.acvd.2012.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/02/2012] [Accepted: 01/05/2012] [Indexed: 02/08/2023]
|
32
|
Majumder S. Odynophagia in sickle cell anemia: pain is not always a crisis. Conn Med 2012; 76:155-158. [PMID: 22666975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This report describes the case of a 30-year-old African American male with sickle cell anemia who presented with odynophagia and chest pain. Clinical examination revealed tachypnea, conjunctival congestion, icterus, facial swelling, engorged neck veins, induration over the upper part of chest and arms and a right chest wall port-a-cath. Subsequent imaging revealed occlusion of both brachiocephalic veins and proximal superior vena cava with a metallic SVC stent in-situ. Recanalization was attempted but guidewires could not be passed across the site ofocclusion. He was then treated with catheter guided t-PA boluses delivered to the site of occlusion and oral anticoagulation.
Collapse
|
33
|
Dib C, Hennebry TA. Successful treatment of SVC syndrome using isolated pharmacomechanical thrombolysis. J Invasive Cardiol 2012; 24:E50-E53. [PMID: 22388315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report 2 cases of superior vena cava (SVC) syndrome treated using isolated pharmacomechanical thrombolysis with angioplasty alone. We also propose a new staged treatment strategy to optimally manage such patients, taking into consideration both cost-effectiveness and the ultimate prognosis.
Collapse
Affiliation(s)
- Chadi Dib
- University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | |
Collapse
|
34
|
Binnani P, Gupta R, Kedia N, Bahadur MM. Unilateral recurrent pleural effusion in a renal transplant patient. Saudi J Kidney Dis Transpl 2012; 23:106-109. [PMID: 22237229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Pleural effusion is a frequent complication in patients undergoing hemodialysis (HD). We report a patient on HD with a novel cause of recurrent unilateral pleural effusion. A 45-year-old female patient on long-term maintenance HD presented to us with recurrent unilateral pleural effusion. She had a history of poor quality dialysis, severe anemia and severe hypertension. Despite correcting these factors and even after undergoing successful renal transplantation, she continued to have recurrent effusion. Left upper extremity venography demonstrated severe stenosis of the subclavian vein and an increased venous flow in the ipsilateral arteriovenous (AV) fistula. Ligation of the AV fistula led to dramatic resolution of the pleural effusion. Hemodialysis patients who develop unexplained pleural effusions ipsilateral to a functioning AV fistula should be investigated for stenosis in the brachiocephalic vein, particularly those patients who have had previous catheterizations of the jugular or subclavian veins on the same side as the effusion. Correcting the stenosis by venous angioplasty and/or ligation of the ipsilateral fistula can dramatically resolve the pleural effusion. A high index of suspicion is required to diagnose this complication for meaningful intervention.
Collapse
Affiliation(s)
- Pooja Binnani
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India.
| | | | | | | |
Collapse
|
35
|
Juszkat R, Zaporowska-Stachowiak I, Stanisławska K, Łuczak J. [Endovascular treatment, with "kissing stents" technique, of superior vena cava syndrome in patient with lung cancer]. Przegl Lek 2012; 69:350-352. [PMID: 23276033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Presented in the article an intravascular method of treatment with stents implantation was effective for symptoms relief and physical signs correction, in 63-year-old patient with advanced lung cancer and SVCS purely responsive to palliative radiotherapy, chemiotherapy (toxic haematological effects) and steroids. The treatment improved the patient's quality of life.
Collapse
Affiliation(s)
- Robert Juszkat
- Pracownia Radiologii Naczyniowej Katedry Radiologii UM im K Marcinkowskiego.
| | | | | | | |
Collapse
|
36
|
Duvnjak S, Andersen P. Endovascular treatment of superior vena cava syndrome. INT ANGIOL 2011; 30:458-461. [PMID: 21804485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The aim of this study was to report our experience with palliative stent treatment of superior vena cava syndrome. METHODS Between January 2008 and December 2009, 30 patients (mean age 60.7 years) were treated with stents because of stenosed superior vena cava. All patients presented clinically with superior vena cava syndrome and according caval stenosis confirmed by computed tomography. The causes of stenoses were non-small cell carcinoma in 22 patients and small cell carcinoma in 8 patients. RESULTS In all patients the stents were placed as intended in all patients there was an immediate clinical improvement with considerable reduction in the edema of upper extremities and head. There was, however, continous dyspnea in five patients (17%) and two patients (7%) had persistent visible collateral venous circulations on the upper chest. There were no stent associated complications. All patients were followed clinically till death and the median follow-up period was 2.8 months (15-420 days). During follow-up three cases of stent thrombosis (one complete and two partial thrombosis) were observed. CONCLUSION Palliative care with stent implantation for superior vena cava syndrome is a minimal invasive and safe procedure with good clinical effect giving the patients a significant better quality of their residual life.
Collapse
Affiliation(s)
- S Duvnjak
- Department of Radiology, Odense University Hospital, Odense, Denmark.
| | | |
Collapse
|
37
|
Veronesi M, Mancini E, Salvati F, Santoro A. [Superior vena cava syndrome unrelated to central venous catheter in a patient on chronic hemodialysis]. G Ital Nefrol 2011; 28:436-440. [PMID: 21809314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 67-year-old woman with end-stage renal disease (polycystic kidney disease) who had been on dialysis for 10 years came to our department for a second opinion about upper left arm edema homolateral to the arteriovenous fistula (AVF). Because of the suspicion of venous stenosis she had already been submitted to angiographic examination of the AVF which, however, did not show any occlusive process. In addition to the kidney problem, the clinical history included dilated cardiomyopathy, and 2 years earlier a biventricular implantable cardioverter defibrillator (ICD) had been placed. The patient had never had a central venous catheter (CVC). She presented a typical superior vena cava syndrome picture with arm, neck and hemifacial edema and superficial cutaneous venous reticulum. The venous pressure during extracoroporeal circulation was high and blood recirculation was documented. Angio-CT was performed to look for a compressive process in the chest, but this was excluded. We then performed a new trans-AVF angiography to study extensively the axillary-subclavian-superior vena cava district. At first, no stenosis or thrombosis was observed, but the presence of ICD and its leads (left-sided implanted) in the anonymous vein created obstacles to diagnosis. Repeated injections of contrast medium and focusing imaging on the leads route allowed us to highlight a venous stenosis in the anonymous vein. Transluminal angioplasty was successfully carried out during the same procedure. 1) In hemodialysis patients the appearance of signs of intrathoracic vein drainage obstacles is not always associated with previous CVC implantation; 2) in the hemodialysis patient, any device (PM, ICD) should be implanted contralaterally to the fistula arm in order to avoid the risk that a venous stenosis may cause AVF dysfunction.
Collapse
Affiliation(s)
- Marco Veronesi
- U.O. Nefrologia, Dialisi e Ipertensione, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | | | | |
Collapse
|
38
|
Ratnarathorn M, Craig E. Cutaneous findings leading to a diagnosis of superior vena cava syndrome: A case report and review of the literature. Dermatol Online J 2011; 17:4. [PMID: 21696684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Superior vena cava syndrome, which occurs in approximately 15,000 persons in the United States annually, consists of a collection of symptoms and signs resulting from the obstruction of the superior vena cava (SVC). An early and prominent symptom of this condition is a constellation of superficial, dilated, vertically oriented and tortuous cutaneous venules or veins above the ribcage margins, often presenting as a blanchable violaceous eruption. Herein, we report a case of superior vena cava syndrome diagnosed in our dermatology clinic.
Collapse
Affiliation(s)
- Mondhipa Ratnarathorn
- University of California at Davis, Department of Dermatology, Sacramento, California, USA
| | | |
Collapse
|
39
|
Taguchi J, Kinoshita I, Akita H. [Superior vena cava syndrome]. Gan To Kagaku Ryoho 2011; 38:518-523. [PMID: 21498977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Superior vena cava(SVC)syndrome is one of the complication of malignant neoplasia, which often occurs in clinical practice. It is caused by obstruction of the SVC by invasion, extrinsic compression by adjacent pathologic processes, or by internal thrombus. They sometimes coexist. The increased venous pressure in the upper body caused by this syndrome results in edema of the head, neck, and arms, which is visually striking but generally of little clinical consequence. But edema may cause a functional compromise of the larynx or pharynx, causing dyspnea, stridor, cough, hoarseness, and dysphagia. Cerebral edema may lead to cerebral ischemia, confusion, coma, and possibly death. We therefore recognize the SVC syndrome as an oncologic emergency. The most common malignant cause of this disease is lung cancer. It is necessary to plan a management strategy after consideration of staging and the histopathologic diagnosis. The most useful imaging study for this disease is CT scanning of the chest with administration of contrast material. Management of the SVC syndrome associated with malignant disease includes both treatment of the cancer and relief of the symptoms of obstruction. Major therapeutic modalities are supportive care and medical management, including chemotherapy, radiotherapy, placement of intravascular stent, and surgery. The presence of the SVC syndrome does not reduce the likelihood ofa cure for the underlying malignant condition, and should not compromise the choice of appropriate therapy.
Collapse
Affiliation(s)
- Jun Taguchi
- Dept. of Medical Oncology, Hokkaido University Graduate School of Medicine, Japan
| | | | | |
Collapse
|
40
|
Molhem A, Sabry A, Bawadekji H, Al Saran K. Superior vena cava syndrome in hemodialysis patient. Saudi J Kidney Dis Transpl 2011; 22:381-386. [PMID: 21422652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Obstruction of blood flow in the superior vena cava (SVC) results in symptoms and signs of SVC syndrome. SVC obstruction can be caused either by invasion or external compression of the SVC by contagious pathologic processes involving the right lung, lymph nodes, and other mediastinal structures, or by thrombosis of blood within the SVC. Occasionally, both mechanisms co-exist. We hereby report a case of a 28-year-old male, Saudi patient who was diagnosed with end-stage renal disease and was maintained on regular hemodiaysis via right jugular vein dual lumen catheter for ten months. Three years later, the patient presented with signs and symptoms suggestive of SVC obstruction that was successfully managed with SVC stenting.
Collapse
Affiliation(s)
- Azeb Molhem
- Prince Salman Center for Kidney Disease, Riyadh, Kingdom of Saudi Arabia
| | | | | | | |
Collapse
|
41
|
Ilhan E, Sahin S, Celebi A. Coronary fistulas can develop collateral vessels: angiographic follow-up of an embolized giant right coronary artery-superior vena cava fistula in a patient with variant angina. J Invasive Cardiol 2011; 23:E12-E14. [PMID: 21297210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 54-year-old man was transferred to our emergency department because of acute inferior myocardial infarction. However, ST-segment elevation resolved after intravenous nitrate administration on admission and coronary angiography revealed a nonobstructive atherosclerotic plaque at the mid-portion of the circumflex artery and a giant tortuous fistula from the right sinus of Valsalva to the superior vena cava. The patient was diagnosed with variant angina and coronary arteriovenous fistula after vasodilator treatment and maximal treadmill stress test. After effective medical treatment of variant angina and successful percutaneous coil embolization of the fistula, the patient had not experienced any angina episodes for 1 year. However, control coronary angiography revealed partial persistence of fistula flow because of new collateral vessels, bridging distal and proximal parts of the occluded segment. We present the first coexistence of coronary to superior vena cava fistula and variant angina in the literature. This report also shows the ability of coronary fistulas to develop collateral vessels, like coronary arteries.
Collapse
Affiliation(s)
- Erkan Ilhan
- Meclis Mahallesi Teraziler Caddesi Sarıbelde Sitesi U7A blok daire: 3 34785 Sancaktepe Istanbul, Türkiye.
| | | | | |
Collapse
|
42
|
Mishra PA, Kausalya R, Jain R. Diagnostic and therapeutic challenges in a critically ill patient in ICU with superior vena cava syndrome--case report. Middle East J Anaesthesiol 2011; 21:105-110. [PMID: 21991741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To highlight the diagnostic and therapeutic challenges associated with the treatment of a patient with superior vena cava syndrome and a coexisting coagulopathy. CLINICAL FEATURES This case report describes a bone marrow transplant patient with graft versus host diseases (GVHD) who was admitted to our intensive care unit with bronchiectasis complicated with nosocomial pneumonia. When he was recovering from pneumonia after prolonged ventilatory support, he developed superior vena cava (SVC) syndrome due to mediastinal lymphadenopathy. The diagnosis was delayed due to associated confounding clinical factors. Because of the rapid deterioration in patient's condition, immediate tissue diagnosis of mediastinal lymph nodes and re-canalization of vena cava by stenting were our priority. He had many other medical problems such as thrombocytopenia, deranged coagulation profile, old cerebral infarction with hemiplegia, seizure disorder and cardiac arrhythmias which complicated the treatment plan. USG guided biopsy followed by stenting of the SVC was done after discussing the risks and benefits with patient's relatives. But, he had bleeding from biopsy site due to deranged coagulation profile. Again for the same reason, he was not given any anticoagulants. Within 24 hours the stent was blocked by clot which was diagnosed by the deteriorating clinical features and repeat CT scan. Then he was given enoxaparin in therapeutic dose and the clot cleared within a day possibly partly due to enoxaparin and partly coagulopathy. CONCLUSION In a bone marrow transplant patient with GVHD, the associated complications can confound the diagnosis of SVC syndrome. Physician has to show high degree of suspicion as it may develop even if patient has coagulopathy due to other factors such mediastinal lymphadenopathy. SVC stent may clot even if the patient has coagulopathy. So, it is advisable to defer the invasive diagnostic procedures such as mediastinal lymph node biopsy till the patient is well stabilized after the stent placement in SVC as it will prevent further use of anticoagulants. Enoxaparin may be helpful in the treatment of stent thrombosis in such patients with multiple complications.
Collapse
Affiliation(s)
- Pragny Adipta Mishra
- Department of Anesthesia and Intensive Care Unit, Sultan Qaboos University Hospital, Muscat, Oman.
| | | | | |
Collapse
|
43
|
Huguet F, Boisserie T, Touboul E. [Emergency and semi-emergencies in radiation therapy]. Rev Prat 2011; 61:81-82. [PMID: 21452552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Florence Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Cancerest, université Paris-VI, 75020 Paris.
| | | | | |
Collapse
|
44
|
Portillo-Sanchez J, Hessein-Abdou Y, Puga-Alcalde E, Perez-Martinez MA, Del Carmen Jimenez-Meneses M, Camacho-Pedrero A, Valdepeñas-Herrero LR. Primary pulmonary artery sarcoma extending retrograde into the superior vena cava. Tex Heart Inst J 2011; 38:77-80. [PMID: 21423477 PMCID: PMC3060731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary pulmonary artery sarcoma is a rare tumor that is highly fatal. It can be misdiagnosed as acute or chronic pulmonary thromboembolic disease. Herein, we report the case of a 22-year-old woman with a preoperative diagnosis of pulmonary embolism and superior vena caval thrombosis. Intraoperatively, an extensive sarcoma was seen to extend retrograde from the pulmonary artery, past the right ventricle and right atrium, and into the superior vena cava. Surgical resection of the tumor and reconstruction of the central pulmonary arteries, followed by adjuvant chemotherapy, relieved the clinical symptoms. The patient remained free of cancer at 14 months postoperatively. We believe that this is the 1st report of a primary pulmonary artery sarcoma that extended retrograde into the superior vena cava.
Collapse
Affiliation(s)
- José Portillo-Sanchez
- Departments of Internal Medicine, Hospital General Ciudad Real, 10034 Ciudad Real, Spain
| | | | | | | | | | | | | |
Collapse
|
45
|
Marwaha RK, Kulkarni KP. Superior vena cava obstruction in childhood acute lymphoblastic leukemia. Indian Pediatr 2011; 48:78-79. [PMID: 21317479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
46
|
Sabiniewicz R. [Comment to article AndraStent - nowy stent obwodowy]. Kardiol Pol 2011; 69:1220. [PMID: 22219091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Robert Sabiniewicz
- Klinika Kardiologii Dziecięcej i Wad Wrodzonych Serca, Gdański Uniwersytet Medyczny, Gdańsk
| |
Collapse
|
47
|
Białkowski J, Szkutnik M, Fiszer R, Głowacki J, Zembala M. Percutaneous dilatation of coarctation of the aorta, stenotic pulmonary arteries or homografts, and stenotic superior vena cava using Andrastents XL and XXL. Kardiol Pol 2011; 69:1213-1219. [PMID: 22219090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Major vessel stenoses are currently successfully treated with stent implantation. Recently, new cobalt-chromium stents (Andrastents XL and XXL, Andramed, Germany) have been introduced into clinical practice. This alloy combines high biocompatibility with radial strength and flexibility. AIM To present our experience with the use of Andrastents XL and XXL for the dilatation of stenosed pulmonary arteries, coarctation of the aorta (CoA), and a stenosed superior vena cava (SVC). METHODS The study group included 24 patients treated with 26 Andrastents. In 7 patients aged 23.3 (range 18-27) years, with the mean body weight of 64.7 (range 50-77) kg, prestenting of a calcified pulmonary homograft was performed using 9 Andrastents XL or XXL (length of 30, 39, or 48 mm) before the Melody valve implantation. In one patient with a long and stiff stenosis, 3 stents were necessary. In 12 patients with native CoA aged 30.1 (range 9-55) years, with the mean body weight of 60 (range 25-105) kg, twelve Andrastents XL or XXL (length of 30, 39, or 48 mm) were implanted. In 4 patients with the right or left pulmonary artery stenosis close to the bifurcation (age 8.5 [range 6-10] years, body weight 27.3 [range 17-33] kg), 4 Andrastents 30 XL were implanted. In one child (age 7.5 years, body weight 21.7 kg) with a iatrogenic SVC stenosis (after 2 venous cannulations necessary for 2 surgical corrections of his double-outlet right ventricle), the stenosed site was dilated using Andrastent 21 XL. RESULTS All procedures were performed successfully. No stent fractures were observed during the follow-up. The mean pressure gradient was reduced from 42.4 to 18 mm Hg (RVOT) in patients who underwent Andrastent and Melody valve implantation, from 54.1 to 13.2 mm Hg in patients with CoA, and from 49 to 21.7 mm Hg in patients with pulmonary artery stenosis. No aneurysm formation, stent migration, or rupture of the treated vessel during stent implantation were observed in any patient. The mean fluoroscopy time during stent implanatation was 6.6 min in CoA, 8.8 min in pulmonary artery stenosis, 24.8 min during implantation of Melody valve (with prestenting of RVOT with Andrastents) and 17.6 min during SVC dilation. Procedural outcomes (evaluated using noninvasive methods) remained favourable during the follow-up (0.5-21 months), with no complications observed. CONCLUSIONS Implantation of Andrastents XL or XXL is a very good therapeutic option in the treatment of major vessel stenoses.
Collapse
Affiliation(s)
- Jacek Białkowski
- Department of Congenital Heart Diseases and Paediatric Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
| | | | | | | | | |
Collapse
|
48
|
Nascimbene A, Angelini P. Superior vena cava thrombosis and paradoxical embolic stroke due to collateral drainage from the brachiocephalic vein to the left atrium. Tex Heart Inst J 2011; 38:170-173. [PMID: 21494530 PMCID: PMC3066820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Thrombosis involving a permanent infusion catheter in the subclavian vein and superior vena cava is relatively common, especially in cancer patients. Edema of the arms and head is a well-known clinical consequence of this thrombosis, with an intrinsic risk of pulmonary embolism; however, systemic embolization into the cerebral circulation has not been reported as a sequela. Herein, we describe the case of a 56-year-old man with metastatic prostate cancer who developed superior vena cava syndrome due to extensive thrombosis in the presence of a central venous catheter that was used for long-term chemotherapy. The patient's case was complicated by a cerebrovascular accident that was most likely caused by a paradoxical air embolism. A clear mechanism for the embolism was provided by a network of collateral veins, which developed between the brachiocephalic vein and the left atrium due to the superior vena cava obstruction and resulted in a right-to-left shunt. We discuss diagnosis and treatment of the condition in our patient and in general terms.
Collapse
Affiliation(s)
- Angelo Nascimbene
- Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA
| | | |
Collapse
|
49
|
Khalid I, Omari M, Khalid TJ, Castillo E, Khandelwal A, Kattoo R. Pericardial tamponade after superior vena cava stent: are nitinol stents safe? Asian Cardiovasc Thorac Ann 2010; 18:294-6. [PMID: 20519302 DOI: 10.1177/0218492310368730] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Placement of a single new-generation nitinol stent resulted in acute pericardial tamponade in a 70-year-old man with superior vena cava syndrome.
Collapse
Affiliation(s)
- Imran Khalid
- Division of Critical Care Medicine, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Wu WD, Chen C, Lin RB, Kang MQ, Zheng W. Mediastinoscopy after stent implantation: a good method for diagnosis and treatment of severe superior vena cava syndrome. Chin Med J (Engl) 2010; 123:2138-2141. [PMID: 20819556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Wei-dong Wu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
| | | | | | | | | |
Collapse
|