Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Is Bilateral Wallstent Placement Superior to Unilateral Placement?

Dinkel, Hans-Peter; Mettke, Birgit; Schmid, Félix; Baumgartner, Iris; Triller, Jürgen; Do, Dai-Do

doi:10.1177/152660280301000416

Cited by 56 publications

(41 citation statements)

References 23 publications

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“…At our institution we compared the results of 61 unilateral stent placements to 22 bilateral stent placements. 37 Technical success was achieved in 99% of patients and clinical success in 91% of patients in the unilateral group, and 90% of patients in the bilateral group, which is similar to other reports. 38 The occlusion rate was significantly lower in the unilateral group than in the bilateral group.…”

Section: Endovascular Treatmentsupporting

confidence: 90%

“…4) is effective and has few complications, [34][35][36] so many institutions, including ours, prefer primary stenting in de novo SVCS and do not restrict stenting to patients with recurrent SVCS. 37 In most of our patients, stenting has markedly improved quality of life, and patients were recurrence-free prior to exitus from the underlying malignancy.…”

Section: Endovascular Treatmentmentioning

confidence: 77%

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Superior Vena Cava Syndrome in Thoracic Malignancies

et al. 2011

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The superior vena cava syndrome (SVCS) comprises various symptoms due to occlusion of the SVC, which can be easily obstructed by pathological conditions (eg, lung cancer, due to the low internal venous pressure within rigid structures of the thorax [trachea, right bronchus, aorta]). The resulting increased venous pressure in the upper body may cause edema of the head, neck, and upper extremities, often associated with cyanosis, plethora, and distended subcutaneous vessels. Despite the often striking clinical presentation, SVCS itself is usually not a life-threatening condition. Currently, randomized controlled trials on many clinically important aspects of SVCS are lacking. This review gives an interdisciplinary overview of the pathophysiology, etiology, clinical manifestations, diagnosis, and treatment of malignant SVCS.

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Section: Endovascular Treatmentsupporting

confidence: 90%

Section: Endovascular Treatmentmentioning

confidence: 77%

Superior Vena Cava Syndrome in Thoracic Malignancies

et al. 2011

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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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“…Excess dilatation may induce adjacent lumen compression or collapse for example presenting as dyspnea due to tracheal collapse. There are various complications (24)(25)(26)(27) related to vena cava stent implantation, including pulmonary edema resulting from a high venous return, stent migration, pulmonary embolus, cardiac tamponade and local pain. To avoid stent migration, the diameter of the stent should be greater than that of the normal vein, and the length of the stent should be 2-4 cm longer than that of the lesion.…”

Section: Discussionmentioning

confidence: 99%

Endoluminal treatment for venous vascular complications of malignant tumors

Xiao

Tong

Shen

2012

Experimental and Therapeutic Medicine

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Abstract. The aim of this study was to explore the efficacy and safety of interventional treatment for venous vascular complications of malignant tumors. Sixty-one patients with venous vascular complications of malignant tumors were treated from May 2002 to May 2009; 37 men and 24 women with mean age 57.8 years (33-82 years). Lesions included acute deep vein thrombosis (n=18); venous stenosis or occlusion (n=32); tumor embolus in vein (n=11). The interventional therapeutic operations included vena cava filter implantation, transcatheter thrombolytic therapy, recanalization, percutaneous transluminal angioplasty (PTA) and stenting. The success rate of thrombolysis and stent implantation, the clinical success rate, complications, recurrence rate of the treated region and survival duration were recorded. Eighteen patients accepted filter and thrombolytic therapy with a success rate of 100%; total urokinase dosage was 7.42±1.49 (4.5-10) million units. Symptoms disappeared (n=15), were palliated (n=3) and thrombi were completely dissolved (n=2), almost completely dissolved (n=8, >90%), partially dissolved (n=6, 50-90%) and not dissolved (n=2, <50%). No pulmonary embolism emerged after the operation. Forty-three patients accepted recanalization, PTA and stent therapy with a success rate of 95.3% (41/43). Symptoms disappeared (n=25), were palliated (n=16) and did not change (n=2) 3 days following the operation. There were no severe complications during the procedure. During followup, 12 patients again suffered symptoms of venous occlusion and 47 patients died of tumor aggravation without symptom recurrence. As a result, interventional therapy has advantages including smaller injuries, well tolerance, high success rate, quick palliation of symptoms and superior clinical efficacy in the treatment of venous vascular complications for malignant tumors.

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Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Is Bilateral Wallstent Placement Superior to Unilateral Placement?

Abstract: Although bilateral Wallstent placement achieved equal technical and clinical success, it tended to confer shorter-lived patency and caused more complications.

Cited by 56 publications

References 23 publications

Superior Vena Cava Syndrome in Thoracic Malignancies

Superior Vena Cava Syndrome in Thoracic Malignancies

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

Endoluminal treatment for venous vascular complications of malignant tumors

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