Abstract 14757: Affected Patients and Clinical Outcomes After Transcatheter Relief of Superior Vena Cava Stenosis

Abstract

Background: Obstruction of the superior vena cava (SVC) is thought to be mostly iatrogenic. Transcatheter interventions relieve stenosis with good long-term results, but there is a paucity of published data. We aim to describe patient characteristics and outcomes after transcatheter SVC intervention. Methods: Single-center, retrospective study of patients who underwent transcatheter SVC intervention from December 2006 to January 2020. Patient characteristics included age, gender, height, weight, and BSA. Clinical parameters included congenital heart disease (CHD), orthotopic heart transplant (OHT), upper extremity central venous line (CVL), extracorporeal membranous oxygenation (ECMO), mortality, and symptoms. Procedural data included pre- and post-intervention SVC pressure gradient, dimensions, and complications. Results: A total of 42 patients (median age 1.5 years, IQR [0.31-15], 64.2% male) underwent 81 procedures with 1 major complication, and 20 patients (47.6%) had re-interventions. 12 patients (31.5%) had symptoms. Affected patient groups were as follows: history of CVL (92.9%), CHD (76.2%), post-OHT (42.9%), and post-ECMO (30.9%). Those who underwent initial balloon angioplasty were significantly younger (mean ± SD: 3.9 ± 6.8 vs. 13.1 ± 11.3 years, p<0.01) and smaller (15.9 ± 20.4 vs. 39.9 ± 31.2 kg, p<0.01) than those with initial stent. A lower pressure gradient and larger post-intervention dimension was achieved after stenting (p<0.01). Re-intervention rates were similar; 50% after balloon and 43.8% after stent, but nearly half of the angioplasty cohort resolved after repeat angioplasty alone, while most stents (85.7%) required serial re-dilation. Affected patient groups were not associated with re-intervention, and there were no significant differences in patient or procedural characteristics between those who did and did not require re-intervention. Conclusions: We describe at-risk groups who warrant surveillance of SVC stenosis in the setting of a low-symptom rate. Strongly consider balloon angioplasty as initial therapy, which may avoid the need for stent and subsequent re-dilations associated with growth. Re-intervention is likely after balloon angioplasty and stenting, but both are safe and effective.