Safety and Efficacy of Stent Graft Implantation for Malignant Superior Vena Cava Syndrome
Stent Graft for Malignant Superior Vena Cava Syndrome
DOI:
https://doi.org/10.1532/hsf.4129Keywords:
Superior Vena Cava Syndrome，, Lung Neoplasms，, StentsAbstract
Background: Patients with malignant superior vena cava syndrome (SVCS) usually require urgent treatments due to a high potential risk of early mortality. Stent implantation can rapidly improve the symptoms of SVCS, which may be beneficial to subsequent anti-tumor therapy. The aim of the study was to evaluate the clinical outcomes of stent graft implantation for the treatment of superior vena cava (SVC) obstruction caused by non-small cell lung carcinoma (NSCLC) with acute post-stenting occlusion.
Methods: Between October 2014 and December 2019, 16 patients were selected for stent graft implantation. Technical success and clinical efficacy were assessed. Stent patency and patient survival rates, as well as the complications were analyzed.
Results: There were 17 stent grafts implanted in 16 patients. The technical success was 100%. The residual stenosis after initial implantation was 64.0 ± 9.0%. The stent expanded to an optimal size in 5.5 ± 2.2 days after the initial deployment. Migration occurred when deploying of the stent graft in one patient; this stent graft was successfully stabilized by a second one. No other complications related to the procedure were found except one migration. At 1, 3, 6, 9 and 12 months, the cumulative survival rates were 100%, 75%, 56%, 19% and 0%, respectively. The mean OS was 173 days. The median survival was 166 days.
Conclusions: Stent graft can be safely used in patients with SVC obstruction with a good long-term patency rate.
References
Ampil FL, Caldito G, Devarakonda S, Vora M, Mills G, Milligan S. 2018. Longevity after radiotherapy of stage III lung cancer: superior vena cava obstruction is associated with early mortality. Ann Palliat Med. 7(2): 242-8.
Angle JF, Siddiqi NH, Wallace MJ, et al. 2010. Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 21(10): 1479-86.
Armstrong BA, Perez CA, Simpson JR, Hederman MA. 1987. Role of irradiation in the management of superior vena cava syndrome. Int J Radiat Oncol Biol Phys. 13(4): 531-9.
Azizzadeh A, Pham MT, Estrera AL, Coogan SM, Safi HJ. 2007. Endovascular repair of an iatrogenic superior vena caval injury: a case report. J Vasc Surg. 46(3): 569-71.
Dyet JF, Nicholson AA, Cook AM. 1993. The Use of the Wallstent Endovascular Prosthesis in the Treatment of Malignant Obstruction of the Superior Vena-Cava. Clin Radiol. 48(6): 381-5.
Gill K, Ettles DF, Nicholson AA. 2000. Recurrent superior vena caval obstruction due to invasion by malignant thymoma: treatment using a stent-graft. Brit J Radiol. 73(873): 1015-7.
Haddad MM, Simmons B, McPhail IR, et al. 2018. Comparison of Covered Versus Uncovered Stents for Benign Superior Vena Cava (SVC) Obstruction. Cardiovasc Intervent Radiol. 41(5): 712-7.
Kunal S, Pathak V, Pathak P. 2019. Superior vena cava syndrome due to pacemaker leads: An Indian report with a review of management practice. Monaldi Arch Chest D. 89(1).
Kuo TT, Chen PL, Shih CC, Chen IM. 2017. Endovascular stenting for end-stage lung cancer patients with superior vena cava syndrome post first-line treatments - A single-center experience and literature review. J Chin Med Assoc. 80(8): 482-6.
Mansour M, Altenburg A, Haage P. 2009. Successful emergency stent implantation for superior vena cava perforation during malignant stenosis venoplasty. Cardiovasc Intervent Radiol. 32(6): 1312-6.
Mose S, Stabik C, Eberlein K, Ramm U, Bottcher HD, Budischewski K. 2006. Retrospective analysis of the superior vena cava syndrome in irradiated cancer patients. Anticancer Res. 26(6C): 4933-6.
Niu S, Xu YS, Cheng L, Cao C. 2017. Stent insertion for malignant superior vena cava syndrome: effectiveness and long-term outcome. Radiol Med. 122(8): 633-8.
Porter JM, Moneta GL. 1995. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg. 21(4): 635-45.
Rowell NP, Gleeson FV. 2002. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. Clin Oncol (R Coll Radiol). 14(5): 338-51.
Sacks D, McClenny TE, Cardella JF, Lewis CA. 2003. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 14(9 Pt 2): S199-202.
Salavitabar A, Flyer JN, Torres AJ, et al. 2018. Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: A single-center experience assessing risk factors and outcomes. Pediatr Transplant. 22(7): e13267.
Volpi S, Doenz F, Qanadli SD. 2018. Superior Vena Cava (SVC) Endovascular Reconstruction with Implanted Central Venous Catheter Repositioning for Treatment of Malignant SVC Obstruction. Front Surg. 5: 4.
Wang ZS, Li CW, Li JX, Wu WJ, Li Y, Shi JG. 2020. Covered versus uncovered stent insertion for malignant superior vena cava obstruction. Minim Invasive Ther Allied Technol. 29(6): 353-8.
Xu YS, Fu YF, Du HT, Li DC. 2015. Palliative Stent Insertion for Acute Malignant Colorectal Obstruction: Long-term Patency and Survival. Surg Laparosc Endosc Percutan Tech. 25(6): 500-4.
Yuuki T, Kanda T, Kimura Y, et al. 2001. Inflammatory cytokines in vitreous fluid and serum of patients with diabetic vitreoretinopathy. J Diabetes Complications. 15(5): 257-9.
