Endovascular Stenting as the First Step in the Overall Management of Malignant Superior Vena Cava Syndrome
July 21st, 2009 Posted by: admin
OBJECTIVE. Self-expandable metal stents were inserted in cancer
patients with superior vena cava (SVC) syndrome to assess their effectiveness
as a primary treatment for symptom relief.
SUBJECTS AND METHODS. Between January 1993 and June 2008, Wallstent
prostheses (n = 208) were inserted in 149 cancer patients (137 men,
12 women; median age, 65 years; age range, 44-84 years) diagnosed as having
SVC syndrome. A single stent was sufficient to restore vessel patency in 102
patients, two stents in 36, three stents in 10, and four stents in one.
Survival data were calculated using Kaplan-Meier curves and multivariate
analysis using the Cox regression method.
RESULTS. Complete resolution of symptoms was achieved in 123
patients within 72 hours, partial resolution in 22 patients, and no response
in only four patients. At follow-up, 30 complications were noted: 16
obstructions, four cases of thrombosis, one partial stent migration to the
right atrium, two cases of incorrect stent placement, six stent
“shortenings,” and one case in which stent expansion was
insufficient. All complications except two were successfully resolved by
repeat stenting or by angioplasty. The median symptom-free survival was 6
months (range, 2 days-43 months). As of June 2008, eight patients were alive
with patent stents.
CONCLUSION. The Wallstent vascular endoprosthesis is an effective
initial treatment in patients with SVC syndrome of neoplastic origin:
Morbidity and complications are minimal, and clinical relief of symptoms is
very rapid. Because the clinical decision for subsequent elective chemotherapy
or radiation therapy is not prejudiced, stenting is a very effective initial
step in the overall palliative treatment of patients with SVC syndrome.
