Treatment of malignant superior vena cava syndrome by endovascular stent insertion Experience on 52 patients with lung cancer

Urruticoechea, Ander; Mesı́a, Ricard; Domínguez, Joan; Falo, C; Escalante, E.; Montes, Ana; Sancho, C.; Cardenal, Felipe; Majem, Margarita; Germà, Josep R.

doi:10.1016/s0169-5002(03)00361-1

Cited by 72 publications

(40 citation statements)

References 21 publications

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“…19 Most studies for salvage SVC stenting after conventional therapy failure report effective relief of venous compression after cancer recurrence, ranging from 81% to 100%, which is similar to the findings in this study. Most studies report a recurrence rate of up to 25% but figures up to 33% to 41% have also been reported.…”

Section: Discussionsupporting

confidence: 90%

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: Discussionsupporting

confidence: 90%

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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“…High doses of corticosteroids are commonly used as adjunctive treatment, but are of unproven benefit [8, 14]. Palliative vascular stenting provides rapid relief of symptoms in 85–100% of cases and is the preferred first line of palliation where this modality is available [15,16,17,18]. Stenting has, however, not been directly compared to radiotherapy in a prospective trial.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Grading of Superior Vena Cava Obstruction

Plekker

Ellis²,

Irusen³

et al. 2007

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Background: Superior vena cava obstruction (SVCO) is commonly caused by neoplastic venous compression and presents with typical symptoms and signs. Its clinical severity presumably depends on the degree of obstruction and the adequacy of venous collateral formation. Objectives: The development of novel clinical and radiological scoring systems based on the postulate that a reproducible relationship exists between the degree of SVCO, the presence of collateral circulation and the extent of clinical symptoms. Methods: We prospectively evaluated consecutive cases of acute and subacute SVCO with a newly developed clinical scoring system, which is based on easily detectable clinical symptoms and signs of SVCO. In parallel, we recorded and scored the degree of SVCO and the extent of collaterals visible on contrast-enhanced computed tomography (CT). Results: Thirty-four cases of SVCO were evaluated: 8 (23.5%) were clinically mild, 16 (47%) moderate and 10 (29.5%) severe. Lung cancer was the underlying histological diagnosis in 94% of cases. Radiologically, 53% had complete SVCO. A well-developed collateral system was found in 14 (41%). A scoring system subtracting a ‘collateral score’ from an ‘obstruction score’ showed a significant correlation with the clinical score (r = 0.75, p < 0.01). Conclusions: Clinical severity of SVCO depends upon the degree of SVCO and is ameliorated by collateral formation. The novel clinical scoring system can predict the underlying CT features in SVCO and may be valuable in the bedside assessment of SVCO severity.

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“…33 SVC stenting (Fig. 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: 99%

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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Treatment of malignant superior vena cava syndrome by endovascular stent insertion Experience on 52 patients with lung cancer

Cited by 72 publications

References 21 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

Clinical and Radiological Grading of Superior Vena Cava Obstruction

Superior Vena Cava Syndrome in Thoracic Malignancies

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