878 Self-expandable metallic stent for superior vena cava syndrome: A safe and effective treatment

Abstract

Stenosis and occlusion of superior vena cava (SVC) is not a rare entity in oncology. By-pass surgery, radiation therapy, and chemotherapy—when effective—are common treatments. Interventionist radiology offers a new way to solve the venous obstruction. Between April 1993 and January 1995, fourteen pts (11 males), aged 48–72 (median 58 years), presenting with SVC syndrome due either to lung cancer and mesothelioma (11 pts), or to breast, gastric, and kidney carcinomas (3 pts), were treated with a metallic stent caval placement. SVC obstruction was confirmed by means ofcomputed tomography and cavography (this last procedure, including venous pressure measurements, was repeated both after stenting and later at 1,3, and 6 months). Stent placing (GianturcoRosch Z-stent) was carried out via percutaneous femoral vein approach, after a 12–72 hour infusion of Urokinase (only in 6 pts showing significant SVC thrombosis) and caval stenosis dilatation with suitable balloon catheters. Heparin and/or warfarin were given for at least 7 days after the procedure, followed by aspirin (0.3 g daily). hnmediately after the Z-stent implantation, all patients experienced a dramatic symptom resolution. Both caval pressure and lesion diameter improved significantly. No inunediate and late complications or stent misplacements were observed. Two patients had a late recurrence of their SVC syndrome. To date, 10 pts are still alive at 4 to 10 months after stent placement. Stenosis and occlusion of superior vena cava (SVC) is not a rare entity in oncology. By-pass surgery, radiation therapy, and chemotherapy—when effective—are common treatments. Interventionist radiology offers a new way to solve the venous obstruction. Between April 1993 and January 1995, fourteen pts (11 males), aged 48–72 (median 58 years), presenting with SVC syndrome due either to lung cancer and mesothelioma (11 pts), or to breast, gastric, and kidney carcinomas (3 pts), were treated with a metallic stent caval placement. SVC obstruction was confirmed by means ofcomputed tomography and cavography (this last procedure, including venous pressure measurements, was repeated both after stenting and later at 1,3, and 6 months). Stent placing (GianturcoRosch Z-stent) was carried out via percutaneous femoral vein approach, after a 12–72 hour infusion of Urokinase (only in 6 pts showing significant SVC thrombosis) and caval stenosis dilatation with suitable balloon catheters. Heparin and/or warfarin were given for at least 7 days after the procedure, followed by aspirin (0.3 g daily). hnmediately after the Z-stent implantation, all patients experienced a dramatic symptom resolution. Both caval pressure and lesion diameter improved significantly. No inunediate and late complications or stent misplacements were observed. Two patients had a late recurrence of their SVC syndrome. To date, 10 pts are still alive at 4 to 10 months after stent placement.