Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy

Fagedet, D.; Thony, F.; Timsit, Jean‐François; Rodière, M.; Monnin-Bares, Valérie; Ferretti, G.; Vesin, Aurélien; Moro-Sibilot, Denis

doi:10.1007/s00270-011-0310-z

Cited by 92 publications

(70 citation statements)

References 25 publications

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“…Only a few case series of more than 50 patients are currently available in the literature. [6][7][8][9][10][11] With the aim of comparing the safety, effectiveness, and outcomes between patients undergoing primary stenting before conventional therapy and salvage stenting after failure of conventional therapy, we report our 15 years' experience in the management of malignant SVCO with Wallstent endoprosthesis (Boston Scientific, Natick [MA], US).…”

Section: Introductionmentioning

confidence: 99%

Endovascular stenting in the management of malignant superior vena cava obstruction: comparing safety, effectiveness, and outcomes between primary stenting and salvage stenting

et al. 2015

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Objective: To compare the safety, effectiveness, and outcomes of primary stenting and salvage stenting for malignant superior vena cava obstruction. Design: Case series with internal comparison.Setting: Regional hospital, Hong Kong. Patients:A total of 56 patients with malignant superior vena cava obstruction underwent 59 stentings from 1 May 1999 to 31 January 2014. Patients' characteristics, procedural details, and outcomes were retrospectively reviewed. Of the 56 patients, 33 had primary stenting before conventional therapy and 23 had salvage stenting after failure of conventional therapy. Statistical analyses were made by Fisher's exact test and Mann-Whitney U test.Results: Primary lung carcinoma was the most common cause of malignant superior vena cava obstruction (primary stenting, 22 patients; salvage stenting, 16 patients; P=0.768), followed by metastatic lymphadenopathy. Most patients had superior vena cava obstruction only (primary stenting, 16 patients; salvage stenting, 15 patients; P=0.633), followed by additional right brachiocephalic vein involvement. Wallstents (Boston Scientific, Natick [MA], US) were used in all patients. Technical success was achieved in all but two patients, one in each group (P=1.000). Only one stent placement was required in most patients (primary stenting, 28 patients; salvage stenting, 20 patients; P=0.726). Procedure time was comparable in both groups (mean time: primary stenting, 89 minutes; salvage stenting, 84 minutes; Endovascular stenting in the management of malignant superior vena cava obstruction: comparing safety, effectiveness, and outcomes between primary stenting and salvage stenting New knowledge added by this study • Endovascular stenting is safe and effective for relieving malignant superior vena cava obstruction (SVCO) in both primary stenting and salvage stenting settings.• Direct comparison between primary stenting and salvage stenting for safety, effectiveness, and outcomes of superior vena cava (SVC) stenting showed no significant differences in number of stents required, success rates, procedure times, symptom relief rates, complication rates, and re-procedure rates between the two groups. Implications for clinical practice or policy • Primary SVC stenting should be considered for patients at their initial presentation with SVCO before conventional therapy by radiotherapy and/or chemotherapy.• Salvage SVC stenting remains a safe and effective treatment for patients with SVCO after failure of radiotherapy and/or chemotherapy.

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Section: Introductionmentioning

confidence: 99%

Endovascular stenting in the management of malignant superior vena cava obstruction: comparing safety, effectiveness, and outcomes between primary stenting and salvage stenting

et al. 2015

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“…In a series of 164 patients, Fagedet and colleagues found an increased rate of complications when stents greater than 16 mm were used. 6 Other authors have proposed that self-expanding stents may be better suited for use in tortuous vessels and when occlusion extends into the brachiocephalic veins. 5 Finally, when thrombus extends into both brachiocephalic veins, unilateral brachiocephalic vein stenting effectively relieves symptoms while avoiding the higher complication and occlusion rates associated with bilateral brachiocephalic vein stenting.…”

Section: Svc Syndromementioning

confidence: 99%

“…5 Finally, when thrombus extends into both brachiocephalic veins, unilateral brachiocephalic vein stenting effectively relieves symptoms while avoiding the higher complication and occlusion rates associated with bilateral brachiocephalic vein stenting. [6][7][8] Symptomatic relief after stent placement is usually rapid. Close to 90% of patients experience some degree of relief within 24 hours of the procedure and another 5% within 5 days.…”

Section: Svc Syndromementioning

confidence: 99%

“…Fagedet and colleagues found a nonsignificant trend toward increased bleeding with heparin, warfarin, and aspirin, and no decrease in reocclusion rates, which brings into question the utility of these therapies. 6 Three to 6 months of postprocedure, antiplatelet therapy with aspirin and clopidogrel is an unproven but common therapeutic regimen.…”

Section: Svc Syndromementioning

confidence: 99%

“…5 Other authors have reported rates of tamponade as high as 1.8%. 6 A total of 16 cases of SVC perforation and hemopericardium have been described in the literature. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The majority of ruptures became clinically apparent near the time of stenting-seven intraprocedurally, six within 1 hour of the procedure, and one more within 24 hours.…”

Section: Svc Rupture and Cardiac Tamponade As A Complication Of Stentingmentioning

confidence: 99%

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Superior Vena Cava Rupture and Cardiac Tamponade Complicating the Endovascular Treatment of Malignant Superior Vena Cava Syndrome: A Case Report and Literature Review

Stevens

Butty

Johnson

2015

Semin intervent Radiol

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A 47-year-old man with known metastatic small cell lung cancer presented with 1 week of right arm swelling, facial flushing, shortness of breath, right hand weakness, and intermittent blurry vision. Physical examination revealed right upper extremity edema and facial plethora. Computed tomography (CT) of the chest confirmed enlargement of a right upper lobe mass causing near-complete occlusion of the right brachiocephalic vein and superior vena cava (SVC) (►Fig. 1), consistent with SVC syndrome (SVCS). After extensive discussion regarding the risks and benefits of the procedure, the patient elected to proceed with endovascular reconstruction of the central veins.Bilateral basilic vein access was obtained, and digital upper extremity venography confirmed near-complete occlusion of the SVC (►Fig. 2). The occlusion was traversed using a 0.035-inch wire and a 5F catheter, and intraluminal crossing was confirmed with contrast injection. Throughand-through access was obtained via the right common femoral vein, and the SVC and brachiocephalic veins were dilated using 8-and 10-mm balloons (►Fig. 3). Venogram immediately following the 10-mm angioplasty demonstrated contrast extravasation into the mediastinum and likely the pericardial space, indicative of SVC rupture (►Fig. 4). Ultrasound revealed a thin pericardial effusion, which, given the patient's history of radiation, was deemed sufficient to cause tamponade. Overlapping 13 mm Â 5 cm Viabahn-covered stents (Gore Medical, Flagstaff, AZ) were placed from the central aspect of the left brachiocephalic vein to the atriocaval junction (►Fig. 5). However, the patient rapidly decompensated, and despite aggressive resuscitation following advanced cardiac life support (ACLS) protocol, including pericardiocentesis, the patient expired on the table.

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Oncologic Emergencies

Yeung

Escalante

2017

Holland‐Frei Cancer Medicine

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Overview Cancer and its treatment can lead to oncologic emergencies. This chapter discusses the approach to acute emergency problems in cancer patients. A list of emergent problems has been selected for focused discussion. Sudden cardiopulmonary arrest is discussed along with special consideration in resuscitation of cancer patients. Arrhythmia, superior vena caval syndrome, pericardial tamponade, and acute hemorrhage are important cardiovascular emergencies. Tumor lysis syndrome can be rapidly fatal, and early recognition and treatment are very important in preventing disastrous outcomes. Pulmonary problems include airway obstruction, pleural effusion, hemoptysis, pneumothorax, and pulmonary embolism. Neurological emergencies include spinal cord compression, brain herniation, and status epilepticus. Neutropenic fever is perhaps the most frequently discussed important topic in oncologic emergency. Other important issues such as perforated viscus, anaphylaxis, and cytokine release syndrome are also discussed. Oncologists and emergency physicians must be aware of these potentially serious acute complications of cancer patients in order to initiate appropriate treatments in a timely manner.

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Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy

Abstract: In malignancy, EVT with self-expandable bare stents is an effective SVCS therapy. These results prompt us to propose treatment with stents earlier in the clinical course of patients with SVCS and to avoid dilatation greater than 16 mm.

Cited by 92 publications

References 25 publications

Endovascular stenting in the management of malignant superior vena cava obstruction: comparing safety, effectiveness, and outcomes between primary stenting and salvage stenting

Endovascular stenting in the management of malignant superior vena cava obstruction: comparing safety, effectiveness, and outcomes between primary stenting and salvage stenting

Superior Vena Cava Rupture and Cardiac Tamponade Complicating the Endovascular Treatment of Malignant Superior Vena Cava Syndrome: A Case Report and Literature Review

Oncologic Emergencies

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