Implantación de endoprótesis para el tratamiento del síndrome de vena cava superior maligno: serie de 56 pacientes de un solo centro

Abstract

ObjectiveTo report a series of stenting procedures for the treatment of malignant superior vena cava (SVC) syndrome. Material and methodsA review conducted from October 2005 to July 2013 retrieved 56 consecutive patients treated for symptomatic malignant SVC syndrome with stenting. ResultsSVC stenting was attempted in 56 patients (46 males, 10 females), aged 34-84years (mean 59.3).The success rate was 49/57 (86%). Success was associated with the type of obstruction classified as: group1 (a —SVC stenosis, or b —unilateral innominate vein occlusion with contralateral innominate vein stenosis and normal SVC), group2 (SVC occlusion excluding bilateral innominate vein occlusion) and group3 (bilateral innominate vein occlusion irrespective of SVC status). Success rates were 100% (39/39), 75% (9/12) and 16.6% (1/6), respectively. These differences were significant for group1 versus group2+3 (p<0.001) and for group2 versus group3 (p=0.032). Acute complications occurred in 9 patients. Patients in whom acute complications occurred were older than the others (67.8 vs. 57.6 years, p=0.019). The procedure-related death rate was 3.5% (n=2). Stent occlusion occurred in 3.5% (n=2). The patient survival was poor (median 2.6; range <1-29.6months), independently of the success of stenting. ConclusionsStenting for malignant SVC syndrome provides immediate and sustained symptomatic relief that lasts until death in this set of patients with a short life expectancy and restores the central venous access for administration of chemotherapy. Technical failure was associated with SVC occlusions and primarily with bilateral innominate vein occlusion.