Long-term success of endovascular treatment of benign superior vena cava occlusion with chylothorax and chylopericardium

Abstract

The most likely etiology of benign obstruction of the superior vena cava (SVC) include fibrosing mediastinitis and iatrogenic etiologies such as sclerosis and obstruction caused by pacemakers and central venous catheter. Percutaneous stenting of SVC has been used with success both in malignant and benign superior vena cava syndrome; however, long-term follow-up of endovascular procedures is not well known. We present a case of a patient with complete occlusion of SVC of benign etiology, presenting dramatically with bilateral chylothorax and chylopericardium with cardiac tamponade, who underwent successful vena caval revascularization with thrombolytic therapy and placement of self-expanding metallic stent. The 42-month follow-up could encourage endovascular procedures even in SVC syndrome of benign etiology.

Results of Intravascular Stent Placement for Fibrosing Mediastinitis

“…Intrathoracic vessel compression secondary to fibrosing mediastinitis has been treated with per-cutaneous stent placement for several years with some success. [9][10][11][12][13][14][15][16][17][18] The flexibility of open-cell design stents was thought to be advantageous for SVC obstruction. However, in-stent stenosis and fibrosis may be a persistent problem for selfexpanding stents.…”

“…Intrathoracic vessel compression secondary to fibrosing mediastinitis has been treated with percutaneous stent placement for several years with some success 9–18 . The flexibility of open‐cell design stents was thought to be advantageous for SVC obstruction.…”

Multimodality Imaging of Focal and Diffuse Fibrosing Mediastinitis

“…Chylothorax is indistinguishable from other pleural effusions at imaging, and fluid analysis is required for diagnosis. Pleural calcifications with or without pleural thickening also may occur (3,4,25,(43)(44)(45)(46)(47).…”

“…Nonsurgical and surgical procedures are reserved for patients with clinical symptoms directly related to compression and/or obstruction of mediastinal structures. Nonsurgical procedures such as percutaneous transluminal angioplasty with or without stent placement may be used in patients with symptomatic or bilateral vascular obstruction (Figs 19, 20) (36,37,41,43,(69)(70)(71)(72). Studies have shown these procedures to be generally safe and effective when performed by experienced providers and in the appropriate patient population.…”

Chylopericardium mit Vena-subclavia-Thrombose

“…BeiF ällenm it primärem Chyloperikard und primäremC hylothorax könnenk eine verursachendenF aktoren festgestellt werden ( 9,10,21,24,28,29). Andererseitsk önnenu .a .T horaxtraumen, mediastinale Radiotherapie, medastinale Fibrose,m aligneL äsionen, Lymphsystem-störungen, Herzoperationenu nd Ve nenthrombosena ls Ursachen vons ekundärem Chyloperikard und sekundärem Chylothorax angeführtwerden (1,7,8,12,14,17,18,23,26).…”