3:36 PM Abstract No. 365 Bifurcated Y-stent placement for treatment of superior vena cava syndrome involving both brachiocephalic veins and superior vena cava

Abstract

To review outcomes after in situ bifurcation Y-stenting for treatment of complex superior vena cava (SVC) syndrome patients with obstruction involving SVC and both brachiocephalic veins (BCV). From January 2001 to August 2017, 18 patients (mean age 54 y; 9 male) with SVC syndrome were treated with the Y-stent technique. All patients had occlusions and/or stenoses of both BCVs and SVC due to malignancy (n = 10), central venous catheterizations (n = 7), or mixed etiologies (n = 1). After recanalization of the obstructive lesions, Y-shaped stents were constructed in situ by placement of a 12 or 14 mm nitinol stent from one BCV to the SVC, selective balloon fenestration of the stent interstices into the other BCV, placement of a contralateral BCV-SVC stent through the fenestration, and symmetrical fenestration of the second stent to minimize exclusion (jailing) of branches. Technical success, clinical success, peri-procedural complications, and long-term outcomes were retrospectively evaluated. All 18 Y-stent deployments were technically successful, resulting in resolution of SVC syndrome symptoms in 100%. Peri-procedural complications included one patient with transient stress-induced cardiomyopathy, but no venous injuries or procedure-related deaths. Of the 12 patients with >30 d follow-up (median 6.4 mo, range 1.1-87.6 mo), 10 (83.3%) had no recurrence of symptoms. Among 7 patients with >30 d contrast-enhanced CTs (median 9.2 mo, range 1.1-70.0 mo), all stents were patent in 5 (71.4%). Two patients, both on chronic hemodialysis with arm arteriovenous fistulas, developed symptom recurrence and in-stent stenoses, requiring secondary interventions. Bifurcation Y-stent placement is a feasible and effective technique for treatment of problematic SVC syndrome caused by obstructive lesions involving bilateral BCVs and SVC. Y-stenting can maintain patency of all branches, and durability appears to be similar to that of simpler anatomy involving only single vessels.