Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome

Abstract

Background: Superior vena cava syndrome management has been traditionally radiation therapy, chemotherapy or chemoradiation, depending on the underlying malignancy involved and individual clinicopathological features of the case. Recent emergence of endovascular stents offer the opportunity for immediate relief of the venous stenosis. This review examines findings from the published series which used endovascular prosthesis for this syndrome with regards to efficacy and safety. Methods: Literature search identified studies using endovascular stents as initial therapy or for recurrence of malignant superior vena cava syndrome. Effectiveness and toxicity from stent placement was assessed. Results: Endovascular stent placement provides immediate haemodynamic relief of venous compression either before or after definitive therapy in the majority of cancer patients. Severe bleedings, cardiopulmonary complications and stent migrations remain significant problems for patient management. Conclusions: Endovascular prosthesis is an effective modality for malignant superior vena cava syndrome with acceptable morbidity. Prospective studies should be performed to determine the optimal anticoagulation regimen.

Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause

“…Surgical interventions with reconstruction of the superior vena cava are possible but can only be performed in few patients selected on the basis of strict criteria [17 -19]. In the last 20 years, it has been shown multiple times that endovascular stents for symptomatic therapy of superior vena cava syndrome have great potential regarding symptom control and prevention of relapse [7,20,28].…”

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

“…Nguyen and colleagues found only one case of SVC rupture among the 884 cases reviewed (0.1%). 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.…”

“…Of the 17 fatalities, 7 were caused by severe hemorrhage, 3 by respiratory events, and 4 by cardiac complications-including 1 cardiac tamponade. 5 In this initial description of SVC stenting, Charnsangavej and colleagues used Gianturco Z stents. 4 Since then, an array of stents have been used to treat SVCS, but there is a paucity of data assessing individual stent performance.…”

“…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. [6][7][8] Symptomatic relief after stent placement is usually rapid.…”

Superior Vena Cava Syndrome in Thoracic Malignancies

“…39 Basically, anticoagulation is recommended after SVC stenting, which might interfere with necessary invasive diagnostic procedures if not done before, but duration and type of anticoagulation remain controversial. However, thrombolytics increased the complication rate after SVC stenting to as high as 10%.…”