Abstract
BackgroundSuperior vena cava (SVC) syndrome is caused by the obstruction of the SVC and can result in significant morbidity and mortality. In contemporary practice, endovascular therapy (ET) has become the standard of care for a majority of these patients. This study is a systematic review and meta-analysis of the available literature to assess technical success, restenosis, and recurrence of SVC syndrome following endovascular intervention.MethodsFor this meta-analysis, we conducted a systematic literature review of PubMed, Cochrane Library, and Embase databases from inception to April 14, 2021 for studies on ET for SVC syndrome. Studies included full-length journal articles on the use of ET among adults with SVC syndrome. Case reports or case series with fewer than 20 patients were excluded. We evaluated the endpoints of technical success rate, restenosis rate, and recurrence rates in SVC syndrome patients after endovascular stenting. The results of this study were calculated using random-effects models.FindingsWe identified 6,012 reports, of which 39 studies met our inclusion criteria and were included for analysis. A total of 2200 patients received ET for SVC syndrome. The weighted technical success rate was 98.8% (95% CI 98.2–99.3) with low heterogeneity (I2=17.4%, p = 0.185), restenosis rate was 10.5% (95% CI 8.4–12.6) with moderate heterogeneity (I2=53.5%, p<0.001), and recurrence rate was 10.8% (95% CI 8.1–13.5) with high heterogeneity (I2=75.8%, p<0.001). Total complication rate was 8.6% (95% CI 7.3%-9.9%) with a mean complication rate of 7.5% (95% CI 4.7%-10.3%).InterpretationOur systematic review revealed high technical success, low restenosis, and low recurrence rates following ET. Collectively, these results support the paradigm of ET as an effective and safe treatment for patients with SVC syndrome.FundingNone.
Highlights
Superior vena cava (SVC) syndrome refers to the constellation of clinical manifestations caused by obstruction of venous flow due to external compression or internal stenosis or occlusion of the SVC
radiation therapy (RT) was viewed as the first-line treatment to relieve obstruction in patients with life-threatening symptoms due to SVC syndrome
Has recently been less frequently used given the efficacy of endovascular stents, complications associated with high dose RT, delayed symptomatic relief, and obscuring of histological diagnosis after RT [27]
Summary
Superior vena cava (SVC) syndrome refers to the constellation of clinical manifestations caused by obstruction of venous flow due to external compression or internal stenosis or occlusion of the SVC. The use of endovascular therapy (ET) in SVC syndrome has not previously been examined in a formal systematic review. Literature search for this meta-analysis was performed using PubMed (NLM), Embase (Elsevier) and Cochrane Central (Wiley) from inception to April 14,2021 with no language restrictions. This study is a systematic review and meta-analysis of the available literature to assess technical success, restenosis, and recurrence of SVC syndrome following endovascular intervention. Interpretation: Our systematic review revealed high technical success, low restenosis, and low recurrence rates following ET. These results support the paradigm of ET as an effective and safe treatment for patients with SVC syndrome.
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