03:36 PM Abstract No. 97 The Wallflex colonic stent adapted for endovascular treatment of malignant IVC obstruction

Abstract

Malignant inferior vena cava (IVC) obstruction may cause debilitating ascites and lower extremity and perineal edema in late stage cancer patients. IVC stent placement can palliate symptoms, but available stents exhibit risk of migration and suboptimal radial strength and sizes. We report our early experience with use of the Wallflex colonic stent adapted for treatment of malignant IVC syndrome. From 2009-2018, self-expanding Wallflex colonic stents (all 25 mm diameter with a 30 mm distal flare; 60, 90, or 120 mm length) were placed in 36 patients (median age 63 yrs) to treat malignant IVC syndrome. Anatomical, procedural, and clinical outcome data were retrospectively evaluated. IVC obstruction was due to primary liver cancer (n = 9) or liver and/or retroperitoneal metastases (n = 27) with mean lesion length of 13.6 cm and baseline pressure gradient of 16.4±5.5 mm Hg (range 6-28). Ten patients had IVC tumor thrombus. Wallflex stents were placed transfemorally in 35 and by jugular vein in 1. The first 3 stents were placed for salvage fixation of Wallstents that had partially migrated into the right atrium. An additional 3 were used to treat recurrent or residual stenosis after Gianturco Z-stent placement. The Wallflex stent was the primary device in the remaining 30. Twelve cases required coaxial placement of Palmaz XL stents for additional radial strength. Technical success was 100% with pressure gradient reduction to 3.7±3.0 mm Hg (range 0-12, p<0.001). Post-stenting anticoagulation was given for 14 patients. In short-term follow-up, leg edema and/or ascites improved in 34 (94.4%) patients, unchanged in 2, unknown in 1. Acute IVC thrombosis occurred in 1 patient with extensive intraluminal tumor thrombus. Cranial stent migration was not seen intraprocedurally. In the one patient with transjugular stent placement, asymptomatic partial migration of the Wallflex stent into the right atrium was incidentally found on CT 38 days later. The Wallflex colonic stent is an attractive option adaptable for use in the palliative treatment of malignant IVC syndrome. Transfemoral stent placement is recommended. Reinforcement with balloon expandable stents may be necessary.