Superior vena cava syndrome: endovascular management.

Walter Kegham Karakhanian,Sergio Quilici Belczak,Walter Zavem Karakhanian

doi:10.1590/1677-5449.180062

Walter Kegham Karakhanian, Sergio Quilici Belczak + Show 1 more

Open Access

https://doi.org/10.1590/1677-5449.180062

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Abstract

BackgroundThe objective of management of superior vena cava syndrome (SVCS) is to promptly alleviate the uncomfortable symptoms. Conventional approaches do not always achieve results as rapidly as endovascular management with stent placement.ObjectivesTo report the experience with endovascular management of SVCS of a Vascular and Endovascular Surgery Service at a Brazilian university hospital.MethodsSymptomatic type III SVCS cases were managed with angioplasty and stent placement in 28 patients aged from 37 to 68 years, between 2002 and 2012. The etiology of SVCS was lung or thoracic cancer in 18 patients, while occlusion of the vein for prolonged use of catheters was the cause in the other 10 cases.ResultsSuperior vena cava occlusion repair was not possible in one oligosymptomatic patient with a very severe lesion. Technical success was achieved in 96.4%. There were two deaths, one due to pulmonary embolism, 24 hours after a successful procedure, and the other due to compression of the airways by tumor mass some hours after the procedure. Clinical success was achieved in all cases of technical success, including one patient who died suddenly, after total regression of SVCS symptoms. Symptoms disappeared 24 hours and 48 hours after management in16 and 8 patients respectively; improvement was slower but progressive after 48 hours in the remaining patients.ConclusionsEndovascular stent placement was effective for management of SVCS, with good technical and clinical success rates and provided prompt relief from symptoms.

Highlights

Superior vena cava syndrome (SVCS) is an uncommon clinical condition[1] and the intensity of clinical manifestations depends on the degree of occlusion or stenosis of the vena cava and on development of collateral circulation, mainly through the azygos vein.In most cases (85%) it occurs in the presence of malignant diseases, bronchogenic carcinomas, lymphomas, and metastatic tumors.[2]
The objective of this study is to report the experience with endovascular management of superior vena cava syndrome (SVCS) of a Vascular and Endovascular Surgery Service at a Brazilian university hospital and to determine technical and clinical success rates
All patients were followed up for 90 days to assess their response to endovascular management in terms of alleviation of symptoms directly related to occlusion of the superior vena cava, recurrence, and complications caused by endovascular procedures

Summary

Introduction

Superior vena cava syndrome (SVCS) is an uncommon clinical condition[1] and the intensity of clinical manifestations depends on the degree of occlusion or stenosis of the vena cava and on development of collateral circulation, mainly through the azygos vein.In most cases (85%) it occurs in the presence of malignant diseases, bronchogenic carcinomas, lymphomas, and metastatic tumors.[2]. The clinical findings classically described include facial, periorbital, cervical, and upper limb edemas followed by venous dilatations of the anterior thoracic wall, characterizing collateral circulation. It is usually not life threatening, SVCS is frequently associated with uncomfortable symptoms, such as dyspnea, dysphagia, and cognitive alterations, and intracranial venous hypertension can result in coma.[6]. Clinical success was achieved in all cases of technical success, including one patient who died suddenly, after total regression of SVCS symptoms. Conclusions: Endovascular stent placement was effective for management of SVCS, with good technical and clinical success rates and provided prompt relief from symptoms

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