Abstract
Objective: To evaluate, in a retrospective study, the clinical efficacy and safety of the self-expanding Nitinol stent in the superior vena cava to alleviate upper venous congestion.Method: In 22 patients (15 men, 7 women), a tumour-related compression of the superior vena cava was diagnosed by spiral CT after intravenous application of contrast medium. Clinically, acute superior vena cava syndrome was found in all patients. Histologically, a bronchial carcinoma was present in 14/22, a lymphoma in 6/22, and mediastinal lymphnode metastases (1 breast carcinoma, 1 malignant melanoma) in 2/22. After a transfemoral approach, cavography was initially performed. The degree of stenosis was classified according to the Stanford classification. In accordance with the degree of stenosis, a self-expanding Nitinol stent was placed.Results: Endovascular stent implantation was conducted without complications in all patients. A marked improvement in acute symptoms was observed clinically within 24 hours in all patients. In the follow-up period of up to 2 years, there were no cases of stent migration. In 7/22 patients, the CT follow-ups revealed tumour progression (3/7 after 3 months, 2/7 after 6 months, and 2/7 after 12 months) with evidence of residual stenosis caused by tumour growth through the stent mesh. During the follow-up period, 15/22 patients died (mean survival 6.4 months).Conclusion: Self-expanding Nitinol stents provide endovascular therapy for superior vena cava syndrome, having a high radial expansive force and the facility to be placed precisely, and alleviating acute, life-threatening symptoms in the palliative situation.
Highlights
In 22 patients (15 men, 7 women, average age 65.9 years), a tumourrelated compression of the superior vena cava (SVC) was diagnosed by multidetector computed tomography (MDCT) of the chest (Table 1)
After cavography (Fig. 1), the stenosis was classified according to the Stanford classification[7] system into 4 types: (i) type I describes a partial obstruction of the SVC with remaining patency and antegrade perfusion of the azygos vein; (ii) type II shows increasing obstruction (90 - 100%); (iii) type III is complete obstruction with reverse circulation in the azygos vein; and (iv) type IV is characterised by complete obstruction of the SVC and the azygos vein, with the development of collateral circulations via the chest wall and the internal mammary veins
The cavography performed before stent placement revealed a partial obstruction of the SVC in 4/22 (18.2%, type I) and in 11/22 (50%, type II) of the patients
Summary
This retrospective study (2009 -2013) assessed the clinical efficacy and safety of self-expanding Nitinol stents (Sinus XL, Optimed, Ettlingen, Germany) in the treatment of acute, tumour-related SVCS. These stents have been authorised for the treatment of cava obstructions and for vena cava syndrome
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