Transcatheter Management of Venous Stenosis

Wax, David F.; Rocchini, Albert P.

doi:10.1007/s002469900247

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…32,33 In addition, endovascular stenting of the pulmonary veins in children has met with little clinical success. 25,[27][28][29][30] On the other hand, stent placement in the pulmonary veins after extrinsic compression in adults has yielded some clinical success. 23 The application of energy in the region of the pulmonary veins results in formation of organizing thrombus, necrotic myocardium, endovascular contraction, and proliferation of elastic lamina, in addition to intimal proliferation.…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

et al. 2003

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Background— Pulmonary vein stenosis has recently been recognized as a complication of radiofrequency ablation for atrial fibrillation. This study evaluates the presentation of affected patients and the role of transcatheter therapy for this patient population. Methods and Results— This study used a retrospective review of data from 19 patients (age, 51±13 years) with pulmonary vein stenosis who underwent catheterization and angiography between December 2000 and December 2002. Quantitative perfusion and spiral CT scans were performed for initial diagnosis and follow-up. The median duration between radiofrequency ablation and the reported onset of respiratory symptoms for 18 of 19 patients was 7.5 weeks (0.1 to 48). After the onset of symptoms, all but two patients were initially misdiagnosed with a symptoms-to-diagnosis duration of 16 weeks (2–59). At initial catheterization, 17 of 19 patients had angioplasty in 30 veins with stent placement in 5 vessels when a flap occurred. Overall vessel diameter increased from 2.6±1.6 to 6.6±2.4 mm ( P <0.0001). There were 4 procedure-related adverse events but no long-term sequelae. Immediate follow-up showed improved flow to involved lung segments. At a median follow-up of 43 weeks (2–92), although repeat angioplasty for restenosis was necessary in 8 of 17 patients, 15 of 17 patients currently have no or minimal persistent symptoms. Conclusions— Pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation is often misdiagnosed. Although further follow-up is necessary to determine long-term success, our data indicate better pulmonary vein flow and symptomatic improvement in the majority of patients undergoing dilation of postablation pulmonary vein stenosis.

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Section: Discussionmentioning

confidence: 99%

“…[23][24][25][26][27][28][29][30][31][32][33][34] Surgical approach has been tried in some instances, with variable results, depending on the technique used, anatomy, and timing of surgery. 24,26,31,34 In children, balloon angioplasty for PVS has been uniformly unsuccessful.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

et al. 2003

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“…Catheterization‐based treatment for SVC stenosis has been described, utilizing either balloon dilation or stent implantation of the SVC []. Both methods have been shown to be safe and effective.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment options for SVC stenosis include surgical relief or catheter‐based interventions, including balloon dilation or endovascular stent implantation. While both methods have been shown to be safe and effective [], little data exist comparing the effectiveness of these percutaneous treatment options. The aim of this study is to determine whether SVC stent implantation is superior to balloon angioplasty for relieving SVC stenosis.…”

Section: Introductionmentioning

confidence: 99%

Endovascular stent provides more effective early relief of SVC obstruction compared to balloon angioplasty

Aldoss

Arain

Menk

et al. 2013

Cathet Cardio Intervent

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Objective To determine whether superior vena cava (SVC) stent implantation is superior to balloon angioplasty for relieving SVC stenosis. Background SVC stent and balloon dilation have been used as treatment for SVC stenosis. Although safe and effective, outcome data comparing the two methods are limited. Methods A Pediatric Cardiac Care Consortium review identified SVC stenosis. Patients who required SVC intervention were divided into two subgroups—balloon dilation (Group A) and stent implantation (Group B). Logistic regression and the log-rank test were used to test the need for re-intervention within 6 months after the initial procedure. Results SVC intervention was performed on 210/637 patients with SVC stenosis (33%). There were 108/210 (51%) patients with balloon dilation (Group A) and 102/210 (49%) with stent implantation (Group B). Re-intervention within 6 months of the initial intervention was more common in Group A compared to Group B [Group A = 31/40 (77.5%); Group B = 5/22 (22.7%)]. The odds-ratio for re-intervention within 6 months of the initial procedure for balloon vs. stent, is 7.3 [95% CI: (2.91, 22.3), P < 0.0001]. In addition, during the first 6 months after an intervention for SVC stenosis the proportion of patients with stent implantation that remained free of re-intervention was significantly higher than after balloon angioplasty (log-rank test, P < 0.0001). Neither age nor weight was significantly associated with the need for re-intervention. Conclusions SVC stent implantation is more effective than angioplasty in relief of SVC obstruction. Weight and age are not risk factors for early re-intervention.

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“…60 Endomyocardial Biopsy Although initially described as a technique for diagnosis of cardiomyopathies, 61 endomyocardial biopsy is the standard technique for detection of rejection after cardiac transplantation. The frequency of surveillance biopsies is a least once a year, but more frequent in the first year after transplantation.…”

Section: Balloon Dilatation Angioplastymentioning

confidence: 99%

Cardiac Catheterization Laboratory: Catheterization, Interventional Cardiology, and Ablation Techniques for Children

Hollinger

Mittnacht

2009

International Anesthesiology Clinics

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Transcatheter Management of Venous Stenosis

Cited by 14 publications

References 25 publications

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

Endovascular stent provides more effective early relief of SVC obstruction compared to balloon angioplasty

Cardiac Catheterization Laboratory: Catheterization, Interventional Cardiology, and Ablation Techniques for Children

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