Palliative Treatment of Superior Vena Cava Syndrome with Nitinol Stents

Abstract

This study aims to retrospectively evaluate the outcomes following nitinol stent placement for malignant superior vena cava syndrome. A total of 25 patients with thoracic malignancies were treated with self-expanding nitinol stents for superior vena cava syndrome (E*Luminexx [Bard GmbH/Angiomed, Karlsruhe, Germany], Sinus-XL [OptiMed Medizinische Instrumente GmbH, Ettlingen, Germany], and Zilver Vena [Cook Medical Inc., Bloomington, IN]). It was seen that the procedural success rate was 76% with all stents deployed as intended and no procedure-related complications but in five patients with 50% residual stenosis and one patient with stent occlusion within 48 hours after stent deployment. Stent occlusion occurred in further two patients during follow-up: one patient developed infection, thrombosis, and occlusion in the stent seen at 2-month follow-up, and one patient had stent occlusion at 4-month follow-up. The clinical success rate was 96%. Stent compression leading to a greater than 50% reduction in stent diameter was observed in three patients at follow-up. Overall 22 patients died at a mean follow-up of 3.5 months for reasons related to their underlying malignancy. It was concluded that the stent treatment for superior vena cava syndrome is a safe treatment with good clinical effect in patients with superior vena cava syndrome in the terminal phase of malignant disease. In this small patient population, no trends were observed which would suggest that outcomes vary by stent type, though additional, large-scale studies are needed.

Keywords

superior vena cava syndrome - stent - treatment - palliative - interventional radiology

• References

• 1 Uberoi R. Quality assurance guidelines for superior vena cava stenting in malignant disease. Cardiovasc Intervent Radiol 2006; 29 (3) 319-322
• 2 Kee ST, Kinoshita L, Razavi MK, Nyman UR, Semba CP, Dake MD. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement. Radiology 1998; 206 (1) 187-193
• 3 Wan JF, Bezjak A. Superior vena cava syndrome. Hematol Oncol Clin North Am 2010; 24 (3) 501-513
• 4 Warren P, Burke C. Endovascular management of chronic upper extremity deep vein thrombosis and superior vena cava syndrome. Semin Intervent Radiol 2011; 28 (1) 32-38
• 5 Klop B, Scheffer MG, McFadden E, Bracke F, van Gelder B. Treatment of pacemaker-induced superior vena cava syndrome by balloon angioplasty and stenting. Neth Heart J 2011; 19 (1) 41-46
• 6 Albers EL, Pugh ME, Hill KD, Wang L, Loyd JE, Doyle TP. Percutaneous vascular stent implantation as treatment for central vascular obstruction due to fibrosing mediastinitis. Circulation 2011; 123 (13) 1391-1399
• 7 Duvnjak S, Andersen P. Endovascular treatment of superior vena cava syndrome. Int Angiol 2011; 30 (5) 458-461
• 8 Lanciego C, Pangua C, Chacón JI , et al. Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome. AJR Am J Roentgenol 2009; 193 (2) 549-558
• 9 Fagedet D, Thony F, Timsit J-F , et al. Endovascular treatment of malignant superior vena cava syndrome: results and predictive factors of clinical efficacy. Cardiovasc Intervent Radiol 2013; 36 (1) 140-149
• 10 Urruticoechea A, Mesía R, Domínguez J , et al. Treatment of malignant superior vena cava syndrome by endovascular stent insertion. Experience on 52 patients with lung cancer. Lung Cancer 2004; 43 (2) 209-214
• 11 Watkinson AF, Yeow TN, Fraser C. Endovascular stenting to treat obstruction of the superior vena cava. BMJ 2008; 336 (7658) 1434-1437
• 12 Andersen PE, Midtgaard A, Brenoe AS, Elle B, Duvnjak S. A new Nitinol stent for use in superior vena cava syndrome. Initial clinical experience. J Cardiovasc Surg, in press
• 13 Smayra T, Otal P, Chabbert V , et al. Long-term results of endovascular stent placement in the superior caval venous system. Cardiovasc Intervent Radiol 2001; 24 (6) 388-394
• 14 Maleux G, Gillardin P, Fieuws S, Heye S, Vaninbroukx J, Nackaerts K. Large-bore nitinol stents for malignant superior vena cava syndrome: factors influencing outcome. AJR Am J Roentgenol 2013; 201 (3) 667-674
• 15 Da Ines D, Chabrot P, Motreff P , et al. Cardiac tamponade after malignant superior vena cava stenting: Two case reports and brief review of the literature. Acta Radiol 2010; 51 (3) 256-259
• 16 Khalid I, Omari M, Khalid TJ, Castillo E, Khandelwal A, Kattoo R. Pericardial tamponade after superior vena cava stent: are nitinol stents safe?. Asian Cardiovasc Thorac Ann 2010; 18 (3) 294-296
• 17 Anand G, Lewanski CR, Cowman SA, Jackson JE. Superior vena cava stent migration into the pulmonary artery causing fatal pulmonary infarction. Cardiovasc Intervent Radiol 2011; 34 (2) , Suppl (Suppl. 02) S198-S201
• 18 Brown KT, Getrajdman GI. Balloon dilation of the superior vena cava (SVC) resulting in SVC rupture and pericardial tamponade: a case report and brief review. Cardiovasc Intervent Radiol 2005; 28 (3) 372-376
• 19 O'Sullivan GJ, Sheehan J, Lohan D, McCann-Brown JA. Iliofemoral venous stenting extending into the femoral region: initial clinical experience with the purpose-designed Zilver Vena stent. J Cardiovasc Surg (Torino) 2013; 54 (2) 255-261