Hybrid Approach: Vascular Surgical and Image-Guided Intervention for BroCa-induced Superior Vena Cava Syndrome (SVCS)

Abstract

Background: The aim of this study was to compare the outcome of a novel hybrid technique with the results of conventional approaches when treating tumor-induced superior vena cava syndrome (SVCS). The failure of a thrombectomy via transjugular aspiration led to an interdisciplinary approach to treat malignant SVCS. Methods: The technique is relatively unknown but is performable if vascular surgeons and interventional radiologists work side by side in the operating room. We give an in-depth description of the hybrid technique, including surgical thrombectomy of the SVC, left brachiocephalic vein and left subclavian vein, occlusion balloon placement, stenting of the SVC and left brachiocephalic vein and the imaging controls. The equipment needed for this approach must be in the operating room and may only be available in bigger hospitals. Results: Tumor-induced SVCS is an urgent case that sometimes cannot wait for radiotherapy or chemotherapy to reduce the tumor mass compressing the SVC. The results of our hybrid technique included almost complete relief of SVCS symptoms within 24 hours. The patient was discharged two days after surgery. Conclusion: Treatment provided the advantages associated with limited invasiveness, i.e., a faster and complication-free recovery period. The procedure may be a suitable alternative to open surgical intervention, as it involves less invasive trauma and has a reasonable risk-benefit ratio with a good chance of technical and clinical success. Further studies are warranted to better assess the complication rates with this hybrid technique.

Key words

Vascular surgery - thoracic surgery - image‐guided intervention - non‐small cell lung carcinoma - hybrid procedure - venous thrombectomy

References

• 1 Bakken A M, Protack C D, Saad W E, Lee D E, Waldman D L, Davies M G. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients.  J Vasc Surg. 2007;  45 776-783
• 2 Kolaric K, Maricic Z, Dujmovic I, Mrsic Z. Experience in the treatment of malignant obstructions of the vena cava superior by means of chemotherapeutic decompression and subsequent irradiation.  Strahlentherapie. 1975;  150 521-525
• 3 Hunter W. The history of an aneurysm of the aorta, with some remarks on aneurysms in general.  Med Obser & Inq. 1757;  1 323-357
• 4 Kim Y I, Kim K S, Ko Y C et al. Endovascular stenting as a first choice for the palliation of superior vena cava syndrome.  J Korean Med Sci. 2004;  19 519-522
• 5 Erbella J, Hess P J, Huber T S. Superior vena cava bypass with superficial femoral vein for benign superior vena cava syndrome.  Ann Vasc Surg. 2006;  20 834-838
• 6 Kalra M, Gloviczki P, Andrews J C et al. Open surgical and endovascular treatment of superior vena cava syndrome caused by nonmalignant disease.  J Vasc Surg. 2003;  38 215-223
• 7 Adamietz I A. Obere Einflußstauung.  Der Onkologe. 1999;  5 1046-1053
• 8 Bierdrager E, Lampmann L E, Lohle P N et al. Endovascular stenting in neoplastic superior vena cava syndrome prior to chemotherapy or radiotherapy.  Neth J Med. 2005;  63 20-23
• 9 Samuels L E, Nyzio J B, Entwistle J W. Superior vena cava rupture during balloon angioplasty and stent placement to relieve superior vena cava syndrome: a case report.  Heart Surg Forum. 2007;  10 E78-E80
• 10 Hochrein J, Bashore T M, O'Laughlin M P, Harrison J K. Percutaneous stenting of superior vena cava syndrome: a case report and review of the literature.  Am J Med. 1998;  104 78-84
• 11 Kee S T, Kinoshita L, Razavi M K, Nyman U R, Semba C P, Dake M D. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement.  Radiology. 1998;  206 187-193
• 12 Greillier L, Barlesi F, Doddoli C et al. Vascular stenting for palliation of superior vena cava obstruction in non-small-cell lung cancer patients: a future ‘standard procedure?.  Respiration. 2004;  71 178-183
• 13 Irving I D, Dondelinger R F, Reidy J F et al. Gianturco self-expanding stent: clinical experience in the vena cava and large veins.  Cardiovasc lntervent Radiology. 1992;  15 328-333
• 14 Kee S T, Kinoshita L, Razavi M K et al. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement.  Radiology. 1998;  206 187-193
• 15 Rosenblum J, Leef J, Messersmith R et al. Intravascular stents in the management of acute superior vena cava obstruction of benign etiology.  J Parenter Enteral Nutr. 1994;  18 362-366
• 16 Rosenthal E, Qureshi S, Tynan M et al. Percutaneous pacemaker lead extraction and stent implantation for superior vena cava occlusion due to pacemaker leads.  Am J Cardiol. 1996;  77 670-672
• 17 Quinn S F, Schuman E S, Hall L et al. Venous stenoses in patients who undergo hemodialysis: treatment with self-expandable endovascular stents.  Radiology. 1992;  183 499-504
• 18 Alimi Y S, Gloviczki P, Vrtiska T J et al. Reconstruction of the superior vena cava: the benefits of postoperative surveillance and secondary endovascular interventions.  J Vasc Surg. 1998;  27 298-299
• 19 Bergoeing R M, Mertens M R, Valdes E F et al. Endovascular treatment of superior vena cava syndrome.  Rev Med Chil. 2006;  134 827-832
• 20 Wilson L, Detterbeck F, Yahalom J. Superior vena cava syndrome with malignant causes.  N Engl J Med. 2007;  356 1862-1869