Stent Placement for the Treatment of Malignant Superior Vena Cava Syndrome—A Single-Center Series of 56 Patients

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 34–84 years (mean 59.3). The success rate was 49/57 (86%). Success was associated with the type of obstruction and was classified as follows: group 1 (a—SVC stenosis, or b—unilateral innominate vein occlusion with contralateral innominate vein stenosis and normal SVC), group 2 (SVC occlusion excluding bilateral innominate vein occlusion) and group 3 (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 group 1 versus group 2+3 (P<.001) and for group 2 versus group 3 (P=.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=.019). Procedure-related death rate was 3.5% (n=2). Stent occlusion occurred in 3.5% (n=2). Patient survival was poor (median 2.6 months; range <1–29.6 months), independent 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.