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SEN I, KALRA M, GLOVICZKI P. Interventions for superior vena cava syndrome. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:674-681. [DOI: 10.23736/s0021-9509.22.12448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Xu B, Wang Y, Lang D, Wang D, Hu S, Xu Q. Application of kissing technique for the treatment of superior vena cava syndrome. Ann Vasc Surg 2022; 84:279-285. [PMID: 35108553 DOI: 10.1016/j.avsg.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/28/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Superior vena cava syndrome is a series of symptoms caused by compression of the superior vena cava and its main branches. Endovascular therapy is now widely accepted because it offers rapid, safe and effective relief of clinical symptoms. Few reports have described the application of kissing technique for the treatment of superior vena cava syndrome. In this report, we review a series of cases in which superior vena cava syndrome was treated by kissing technique and we share our experience. METHODS Our institute treated 22 patients with SVCS by endovascular intervention from November 2016 to June 2021; among them, the kissing technique was used in 10 cases and achieved satisfactory results. This is a retrospective evaluation and analysis of 10 patients with superior vena cava syndrome who were treated by endovascular intervention using the kissing technique from May 2018 to April 2021 in Hwa Mei Hospital, University of Chinese Academy of Sciences. Based on literatures, we summarize the diagnosis, treatment, and surgical experience. RESULTS All patients underwent the implantation of the kissing stents, and the technical success rate was 100%. The symptoms and signs of intravenous obstruction in all patients were alleviated or disappeared within one to three days after the procedure. During the follow-up period, nine patients remained free from any clinical signs or symptoms, and one patient died one month after the procedure due to the progression of malignant tumors. CONCLUSION As a palliative intervention, the kissing technique for the treatment of superior vena cava syndrome caused by malignant tumors is safe, rapid, and effective. Successful endovascular therapy can quickly relieve symptoms, improve the patient's quality of life, and provide more opportunities for subsequent anti-tumor treatment.
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Affiliation(s)
- Bin Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Yi Wang
- Department of Radiotherapy and chemotherapy, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Dehai Lang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Di Wang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Songjie Hu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China
| | - Qiyang Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Ningbo, Zhejiang Province, China.
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Aung EYS, Khan M, Williams N, Raja U, Hamady M. Endovascular Stenting in Superior Vena Cava Syndrome: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2022; 45:1236-1254. [PMID: 35821122 PMCID: PMC9458578 DOI: 10.1007/s00270-022-03178-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 05/15/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). METHODS MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper-Pearson estimation. RESULTS Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0-97.5%) and 92.8% (95% CI 91.7-93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0-93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). CONCLUSIONS This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. LEVEL OF EVIDENCE Level III, systematic review of retrospective cohort studies.
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Affiliation(s)
- Eri Yin-Soe Aung
- Imperial College School of Medicine, Imperial College London, Sir Alexander Fleming Building, Imperial College Road, London, SW72DD UK
| | - Maha Khan
- Imperial College School of Medicine, Imperial College London, Sir Alexander Fleming Building, Imperial College Road, London, SW72DD UK
| | - Norman Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, W1W 7JN UK
| | - Usman Raja
- Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
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Li N, Zeng N, Chen B, Huang Y. Endovascular treatments of tunneled central venous catheter-induced superior vena cava complete occlusion via through-and-through technique. Hemodial Int 2020; 25:35-42. [PMID: 33040490 DOI: 10.1111/hdi.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Superior vena cava occlusion (SVCO) induced by tunneled central venous catheter (tCVC) is an uncommon but challenging complication of hemodialysis patients. The aim of this study was to access the efficacy, safety, and patency of stents in tCVC-related SVCO via through-and-through technique. METHOD We retrospectively identified seven patients with benign SVCO secondary to tCVC treated with endovascular approaches successfully between 1 March 2013 and 31 October 2019. Patients' demographic data, clinical signs and symptoms, and imaging data were followed up and recorded. RESULTS Technical success was achieved in all cases. All the patients were performed with percutaneous transcatheter angioplasty (PTA) and subsequently stent placement via the through-and-through technique. During follow-up, four patients underwent secondary interventions, including PTA and/or stent placement. The primary patency after 3, 6, 9 and 12 months was 100%, 100%, 86% and 86%, and secondary patency after 12 months was 100%. No procedure-related deaths occurred. CONCLUSIONS Endovascular management of SVCO is a safe and effective approach. CT examination can provide a direction for endovascular treatment and periodic surveillance.
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Affiliation(s)
- Nan Li
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ni Zeng
- Research Center of Medical Sciences, Guangdong General Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Bin Chen
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonghui Huang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Riahi M, Velasco Forte MN, Byrne N, Hermuzi A, Jones M, Baruteau AE, Valverde I, Qureshi SA, Rosenthal E. Early experience of transcatheter correction of superior sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage. EUROINTERVENTION 2019; 14:868-876. [PMID: 30012542 DOI: 10.4244/eij-d-18-00304] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Superior sinus venosus atrial septal defect (SVASD) is commonly associated with partial anomalous pulmonary venous drainage (PAPVD). We aimed to describe the first series of percutaneous SVASD and PAPVD correction using a two-step simulation for procedural planning. METHODS AND RESULTS Patients with SVASD and right PAPVD with a clinical indication for correction were selected. They underwent an ex vivo procedural simulation on a 3D-printed model followed by an in vivo simulation using balloon inflation in the targeted stent landing zone. The percutaneous procedure consisted in deploying a 10-zig custom-made covered stent in the SVC-RA junction. Five patients were referred for preprocedural evaluation and were deemed suitable for percutaneous correction. The procedure was successful in all patients with no residual interatrial shunt and successful redirection of the pulmonary venous drainage to the left atrium. At a median clinical follow-up of 8.1 months (2.6-19.8), no adverse events were noted, and all patients showed clinical improvement. During follow-up, transthoracic echocardiography and multidetector cardiac tomography in four patients or invasive angiography in one patient demonstrated a patent SVC stent, and no residual SVASD and unobstructed PV drainage in all patients. CONCLUSIONS In selected patients using a two-stage simulation strategy, percutaneous correction of SVASD with PAPVD is feasible and safe, and led to favourable short-term outcomes.
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Affiliation(s)
- Mounir Riahi
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Tan GM, Chi KWK, Yan BPY. Mid-term Results of a Novel Dedicated Venous Stent for the Treatment of Chronic Thoracic Central Vein Obstruction of Benign Aetiology. Eur J Vasc Endovasc Surg 2018; 57:417-423. [PMID: 30404722 DOI: 10.1016/j.ejvs.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/06/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Endovascular treatment is indicated for the treatment of symptomatic thoracic central vein obstruction (TCVO) but is limited by high rates of restenosis and the need for re-intervention. The aim was to assess the safety and mid-term patency of a novel dedicated venous stent for the treatment of TCVO of benign aetiology. METHODS This was a prospective single centre observational study of 20 patients (median age 65 years, 50% male) referred for the treatment of symptomatic chronic (>three months duration) TCVO between May 2016 and January 2018. Balloon angioplasty with implantation of a self expanding nitinol stent (Vici, Boston Scientific, Marlborough, MA, USA) was performed in all patients. Clinical records including demographics, aetiologies and types of TCVO, and procedural details were recorded. Patients were followed up clinically at one, six, and 12 months. Primary and assisted primary patency were reported. RESULTS All 20 lesions were total occlusions, of which 55% (n = 11) were de novo, 10% (n = 2) peri-stent restenosis, and 35% (n = 7) in-stent re-occlusion. The aetiology of TCVO was predominantly (95%) because of multiple or prolonged central venous line insertion. The procedural success rate was 90% (18/20) with no procedural complications. The median follow up was 13.5 months. Primary patency was 100% at 6 months. One patient required re-intervention for stent in segment restenosis at 7 months. The assisted primary patency rate was 100% at 12 months. CONCLUSION Endovascular treatment of benign TCVO with the novel dedicated venous stent was safe and effective in relieving obstructive symptoms with excellent one year patency rates.
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Affiliation(s)
- Guang Ming Tan
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ken Wai Kin Chi
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Bryan Ping Yen Yan
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia.
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Is Long-Term Anticoagulation Required after Stent Placement for Benign Superior Vena Cava Syndrome? J Vasc Interv Radiol 2018; 29:1741-1747. [PMID: 30396845 DOI: 10.1016/j.jvir.2018.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/15/2018] [Accepted: 07/23/2018] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To identify whether symptom relief and stent patency vary with use of long-term anticoagulation after stent placement for benign superior vena cava (SVC) syndrome. MATERIALS AND METHODS Patients with benign SVC syndrome treated with stent placement between January 1999 and July 2017 were retrospectively identified (n = 58). Average age was 49 years (range, 24-80 y); 34 (58%) were women, and 24 (42%) were men. Average follow-up was 2.4 years (range, 0.1-11.1 y, SD 2.6). Of cases, 37 (64%) were due to a long-term line/pacemaker, and 21 (36%) were due to fibrosing mediastinitis. After stent placement, 36 (62%) patients were placed on long-term anticoagulation, and 22 (38%) were not placed on anticoagulation. Percent stenosis was evaluated on follow-up imaging by dividing smallest diameter of the stent by a normal nonstenotic segment of the stent and multiplying by 100. RESULTS Technical success was achieved in all cases. There was no significant difference in number of patients who reported a return of symptoms characteristic of benign SVC syndrome between the anticoagulated (16 of 36; 44.4%) and nonanticoagulated (11 of 22; 50%) groups (P = .68). There was no significant difference in the mean percent stenosis between the anticoagulated (40.4% ± 34.7% [range, 0-100%]) and nonanticoagulated (32.1% ± 29.2% [range, 1.7%-100%]) groups (P = .36). No significant difference was found in the time (days) between date of procedure and date of return of symptoms (anticoagulated, 735.9 d ± 1,003.1 [range, 23-3,851 d]; nonanticoagulated, 478 d ± 826.6 [range, 28-2,922 d]) (P = .49). There was no difference in primary patency between groups (P = .59). Finally, 1 patient (2.8%) in the anticoagulated group required surgical intervention, whereas none in the nonanticoagulated group required surgical intervention. CONCLUSIONS No significant difference was observed in clinical and treatment outcomes in patients who did and did not receive anticoagulation after stent placement for benign SVC syndrome. Management of benign SVC syndrome after stent placement may not require anticoagulation if confirmed by additional studies.
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Hooker JB, Hawkins BM, Abu-Fadel MS. Endovascular Stenting in 2 Patients with Benign Superior Vena Cava Syndrome. Tex Heart Inst J 2018; 45:264-269. [PMID: 30374243 DOI: 10.14503/thij-17-6263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Superior vena cava syndrome has typically been associated with malignant conditions; however, the number of benign cases has started to grow as the use of upper-extremity venous lines and implantable cardiac devices increases. Whereas endovascular techniques are standardly used to treat patients with malignancies, the optimal care of patients with benign causes is less clear because they typically have longer life expectancies. We describe 2 cases of benign superior vena cava syndrome successfully managed with endovascular stenting, and we review the relevant literature. Of 145 cases in 10 series (average follow-up time, 24 mo), 96% of patients experienced symptomatic relief after endovascular management, with a primary patency rate of 66% and a secondary rate of 93%. Although few data exist to compare open surgical and endovascular techniques directly, both approaches appear to produce similar rates of patency. Both approaches frequently necessitate secondary intervention to maintain patency, but endovascular management is associated with fewer complications. We conclude that endovascular management of benign superior vena cava syndrome is a safe, effective, and reasonable initial management approach.
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Harrison B, Hao F, Koney N, McWilliams J, Moriarty JM. Caval Thrombus Management: The Data, Where We Are, and How It Is Done. Tech Vasc Interv Radiol 2018; 21:65-77. [DOI: 10.1053/j.tvir.2018.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Haddad MM, Simmons B, McPhail IR, Kalra M, Neisen MJ, Johnson MP, Stockland AH, Andrews JC, Misra S, Bjarnason H. Comparison of Covered Versus Uncovered Stents for Benign Superior Vena Cava (SVC) Obstruction. Cardiovasc Intervent Radiol 2018; 41:712-717. [PMID: 29492630 DOI: 10.1007/s00270-018-1906-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/17/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify whether long-term symptom relief and stent patency vary with the use of covered versus uncovered stents for the treatment of benign SVC obstruction. METHODS AND MATERIALS We retrospectively identified all patients with benign SVC syndrome treated to stent placement between January 2003 and December 2015 (n = 59). Only cases with both clinical and imaging follow-up were included (n = 47). In 33 (70%) of the patients, the obstruction was due to a central line or pacemaker wires, and in 14 (30%), the cause was fibrosing mediastinitis. Covered stents were placed in 17 (36%) of the patients, and 30 (64%) patients had an uncovered stent. Clinical and treatment outcomes, complications, and the percent stenosis of each stent were evaluated. RESULTS Technical success was achieved in all cases at first attempt. Average clinical and imaging follow-up in years was 2.7 (range 0.1-11.1) (covered) and 1.7 (range 0.2-10.5) (uncovered), respectively. There was a significant difference (p = 0.044) in the number of patients who reported a return of symptoms between the covered (5/17 or 29.4%) and uncovered (18/30 or 60%) groups. There was also a significant difference (p = < 0.001) in the mean percent stenosis after stent placement between the covered [17.9% (range 0-100) ± 26.2] and uncovered [48.3% (range 6.8-100) ± 33.5] groups. No significant difference (p = 0.227) was found in the time (days) between the date of the procedure and the date of clinical follow-up where a return of symptoms was reported [covered: 426.6 (range 28-1554) ± 633.9 and uncovered 778.1 (range 23-3851) ± 1066.8]. One patient in the uncovered group had non-endovascular surgical intervention (innominate to right atrial bypass), while none in the covered group required surgical intervention. One major complication (SIR grade C) occurred that consisted of a pericardial hemorrhagic effusion after angioplasty that required covered stent placement. There were no procedure-related deaths. CONCLUSION Both covered and uncovered stents can be used for treating benign SVC syndrome. Covered stents, however, may be a more effective option at providing symptom relief and maintaining stent patency if validated by further studies.
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Affiliation(s)
- Mustafa M Haddad
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA.
| | - Benjamin Simmons
- Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Ian R McPhail
- Departments of Cardiology and Vascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Manju Kalra
- Department of Vascular Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Melissa J Neisen
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Matthew P Johnson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Andrew H Stockland
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - James C Andrews
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Sanjay Misra
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Haraldur Bjarnason
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
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Primary Stenting Is Not Necessary in Benign Central Venous Stenosis. Ann Vasc Surg 2017; 46:322-330. [PMID: 28807744 DOI: 10.1016/j.avsg.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/09/2017] [Accepted: 07/17/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study is to evaluate central venous stenosis (CVS) etiologies and presentation within a vascular surgery practice. We evaluated endovascular treatment modalities and the patency rates of our interventions. METHODS Five-year retrospective review of endovascular intervention for CVS. Patient demographics, medical comorbidities, and variables were collected including etiology, indwelling device, previous upper extremity (UE) deep venous thrombosis, long-term UE indwelling device (defined as >30 days), malignancy status, hypercoagulable disorders, history of radiation or mediastinal fibrosis or masses, and anticoagulation and/or antiplatelet therapy. Follow-up variables included symptoms, imaging, and anticoagulation and/or antiplatelet utilization. Living patients without recent follow-up were contacted with a telephone survey regarding current symptoms. Patency was evaluated by imaging or clinically by recurrence of signs or symptoms through January 2016. RESULTS A total of 61 patients underwent attempted endovascular CVS interventions from January 2007 to 2013. Forty-seven (83%) patients had successful interventions. There were 22 (36%) end-stage renal disease (ESRD) patients. The primary etiology in 79% of patients was benign CVS secondary to an indwelling device. Eighty-nine percent of the interventions were primary angioplasty (PTA). The overall primary patency rates at 6, 12, and 24 months were 49%, 34%, and 24%, respectively. Secondary patency rates at 6, 12, and 24 months were 97%, 93%, and 88%, respectively. There were no statistical differences in demographics or outcomes in patients treated successfully with PTA or those requiring stenting. There was no statistical difference in the patency rates between ESRD and non-ESRD patients. Previous interventions were not a predictor of loss of patency. CONCLUSIONS Our study supported the rising trend of benign CVS predominantly secondary to indwelling devices. We demonstrated acceptable secondary patency with PTA alone. This study adds further support for a primary angioplasty strategy in treating benign CVS. The optimal endovascular treatment for benign CVS is still undefined.
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Lai CH, Chang WC, Liu TJ, Lee WL, Su CS. Endovascular Treatment of Concomitant Obstructions of a Denver Drainage Catheter and Superior Vena Cava in a Patient With Liver Cirrhosis. Int Heart J 2017; 58:447-450. [PMID: 28484121 DOI: 10.1536/ihj.16-300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With the increased use of intravascular catheters and devices, they have become the major non-malignant cause of superior vein cava (SVC) syndrome. We report a patient with liver cirrhosis who had received a peritoneovenous drainage catheter for refractory ascites, and then developed SVC syndrome because of concomitant occlusions of both the SVC and the drainage catheter. The patient regained patency of both the occluded vessel and the drainage catheter through percutaneous transluminal venoplasty, and there was dramatic improvement of clinical symptoms and good performance of the drainage catheter. Percutaneous intervention may be a feasible and effective therapy for SVC syndrome and intra-catheter thrombosis-related dysfunction.
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Affiliation(s)
- Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
| | - Wei-Chun Chang
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
| | - Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital.,Institute of Clinical Medicine, Cardiovascular Research Center, and Department of Medicine, National Yang Ming University School of Medicine
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A Review of Open and Endovascular Treatment of Superior Vena Cava Syndrome of Benign Aetiology. Eur J Vasc Endovasc Surg 2016; 53:238-254. [PMID: 28007450 DOI: 10.1016/j.ejvs.2016.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/13/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND The widespread use of central venous catheters, ports, pacemakers, and defibrillators has increased the incidence of benign superior vena cava syndrome (SVCS). This study aimed at reviewing the results of open and endovascular treatment of SVCS. METHOD Medical literature databases were searched for relevant studies. Studies with more than five adult patients, reporting separate results for the SVC were included. Nine studies reported the results of endovascular treatment of SVCS including 136 patients followed up for a mean of 11-48 months. Causes of SVCS were central venous catheters and pacemakers (80.6%), mediastinal fibrosis (13.7%), and other (5.6%). Percutaneous transluminal angioplasty (PTA) and stenting was performed in 73.6%, PTA only in 17.3%, and thrombolysis, PTA, and stenting in 9%. Four studies reported the results of open repair of SVCS including 87 patients followed up between 30 months and 10.9 years. The causes were mediastinal fibrosis (58.4%), catheters and pacemakers (28.5%), and other (13%). Operations performed included a spiral saphenous interposition graft, other vein graft, PTFE graft, and human allograft. Thirteen patients required re-operations (15%) before discharge mainly for graft thrombosis. RESULTS In the endovascular group technical success was 95.6%. Thirty day mortality was 0%. Regression of symptoms was reported in 97.3%. Thirty-two patients (26.9%) underwent 58 secondary procedures. In the open group the 30 day mortality was 0%. Symptom regression was reported in 93.5%. Twenty-four patients (28.4%) underwent a total of 33 secondary procedures. CONCLUSIONS Endovascular is the first line treatment for SVCS caused by intravenous devices, whereas surgery is most often performed for mediastinal fibrosis. Both treatments show good results regarding regression of the symptoms and mid-term primary patency, with a significant incidence of secondary interventions.
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A “Train-Track” Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection. Cardiovasc Intervent Radiol 2016; 40:629-633. [DOI: 10.1007/s00270-016-1528-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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15
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Shatila W, Almanfi A, Massumi M, Dougherty KG, Parekh DR, Strickman NE. Endovascular Treatment of Superior Vena Cava Syndrome via Balloon-in-Balloon Catheter Technique with a Palmaz Stent. Tex Heart Inst J 2016; 43:520-523. [PMID: 28100973 DOI: 10.14503/thij-15-5479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Superior vena cava syndrome is a well-known disease entity that carries substantial rates of morbidity and mortality. Although most cases of superior vena cava syndrome are secondary to a malignant process, additional causes (such as mediastinal fibrosis, pacemaker lead implantation, or central venous catheter placement) have been reported. Multiple treatment options include percutaneous transluminal angioplasty, stent implantation, thrombolysis, mechanical thrombectomy, and venous grafting. We present a case of superior vena cava syndrome in a symptomatic 30-year-old woman who obtained complete relief of obstruction and marked symptomatic improvement through venoplasty and stenting, aided by our use of a balloon-in-balloon catheter system.
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Percutaneous endovascular management of chronic superior vena cava syndrome of benign causes : long-term follow-up. Eur Radiol 2016; 27:97-104. [DOI: 10.1007/s00330-016-4354-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/03/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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17
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Mueller GC, Lu JC, Mahani MG, Dorfman AL, Agarwal PP. MR Imaging of Thoracic Veins. Magn Reson Imaging Clin N Am 2016; 23:293-307. [PMID: 25952521 DOI: 10.1016/j.mric.2015.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
MR imaging of thoracic veins is performed to evaluate the heart and thoracic vasculature. The protocol can be customized to the clinical question. In the embryo, systemic and pulmonary vein development is closely related to heart development. Congenital anomalies of the thoracic veins are strongly associated with other cardiac and situs abnormalities. Acquired venous abnormalities are often iatrogenic, or secondary to malignancy. This article discusses development and anatomy of the thoracic venous systems, clinical MR imaging methods for their evaluation, and illustrates the MR imaging appearance of congenital and acquired abnormalities of systemic thoracic veins, coronary sinus, and pulmonary veins.
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Affiliation(s)
- Gisela C Mueller
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109-2713, USA.
| | - Jimmy C Lu
- Department of Pediatrics, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109-4204, USA; Department of Radiology, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109-4204, USA
| | - Maryam Ghadimi Mahani
- Department of Radiology, C.S. Mott Children's Hospital, University of Michigan, Floor 3 Recp A Room 3660A, 1540 East Hospital Drive SPC 4252, Ann Arbor, MI 48109, USA
| | - Adam L Dorfman
- Department of Pediatrics, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109-4204, USA; Department of Radiology, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109-4204, USA
| | - Prachi P Agarwal
- Department of Radiology, Cardiovascular Center, University of Michigan, Floor 5 Room 5383, 1500 East Medical Center Drive SPC 5868, Ann Arbor, MI 48109, USA
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Mokry T, Bellemann N, Sommer CM, Heussel CP, Bozorgmehr F, Gnutzmann D, Kortes NA, Kauczor HU, Radeleff B, Stampfl U. Retrospective study in 23 patients of the self-expanding sinus-XL stent for treatment of malignant superior vena cava obstruction caused by non-small cell lung cancer. J Vasc Interv Radiol 2015; 26:357-65. [PMID: 25638748 DOI: 10.1016/j.jvir.2014.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/17/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate retrospectively the self-expanding nitinol Sinus-XL stent (OptiMed, Ettlingen, Germany) for the treatment of superior vena cava (SVC) obstruction caused by non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Between October 2009 and December 2012, 23 patients (7 women and 16 men; age, 62.5 y ± 8.5) with stage IIIA (1 patient), IIIB (4 patients) or IV (18 patients) NSCLC and acute SVC obstruction were scheduled for urgent stent implantation. The primary study endpoints were technical success (defined as accurate stent placement with complete coverage of the obstructed SVC), residual stenosis < 30%, and clinical efficacy. Complications were assessed as a secondary study endpoint. RESULTS There were 26 stents implanted in 23 patients. The technical success was 100%. Stent dilation was performed after deployment in 18 cases (78%). Stent migration into the right atrium occurred immediately after deployment in one patient; however, this stent was successfully repositioned and stabilized by a second stent. The clinical symptoms improved at least one category according to the International Consensus Committee on Chronic Venous Disease after stent implantation in all but one patient. The mean clinical follow-up was 66 days ± 83 (range, 1-305 d). Three minor complications (13%) and one major complication (4%) occurred. CONCLUSIONS Implantation of the self-expanding Sinus-XL stent for treatment of SVC obstruction caused by NSCLC is a safe and effective urgent treatment in this palliative setting.
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Affiliation(s)
- Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Nadine Bellemann
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Claus P Heussel
- Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxlinik University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Daniel Gnutzmann
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Nikolas A Kortes
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Hans U Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Ulrike Stampfl
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Song J, McDermott VM, Ryan P, Bird BRH. Myxofibrosarcoma directly invading superior vena cava causing obstruction successfully relieved by endovascular stent. Acta Oncol 2015; 54:141-3. [PMID: 25365347 DOI: 10.3109/0284186x.2014.953261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jiheon Song
- School of Medicine, University College Cork , Cork , Ireland
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20
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FU HAIXIA, HUANG XINMIAO, ZHONG LI, OSBORN MICHAELJ, BJARNASON HARALDUR, MULPURU SIVA, ZHAO XIANXIAN, FRIEDMAN PAULA, CHA YONGMEI. Outcome and Management of Pacemaker-Induced Superior Vena Cava Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1470-6. [DOI: 10.1111/pace.12455] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/15/2014] [Accepted: 05/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- HAI-XIA FU
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
- Department of Cardiovascular Diseases; Henan Provincial People's Hospital; Henan China
| | - XIN-MIAO HUANG
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
- Department of Cardiovascular Diseases; Changhai Hospital; Second Military Medical University; Shanghai China
| | - LI ZHONG
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
- Department of Cardiology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - MICHAEL J. OSBORN
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - HARALDUR BJARNASON
- Division of Cardiovascular Diseases; Department of Radiology; Mayo Clinic; Rochester Minnesota
| | - SIVA MULPURU
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - XIAN-XIAN ZHAO
- Department of Cardiovascular Diseases; Changhai Hospital; Second Military Medical University; Shanghai China
| | - PAUL A. FRIEDMAN
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - YONG-MEI CHA
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
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Rapid guiding catheter swapping for management of rupture during percutaneous venoplasty for idiopathic occlusion of superior vena cava. Cardiovasc Interv Ther 2014; 30:171-5. [DOI: 10.1007/s12928-014-0269-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
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Rachapalli V, Boucher LM. Superior Vena Cava Syndrome: Role of the Interventionalist. Can Assoc Radiol J 2014; 65:168-76. [DOI: 10.1016/j.carj.2012.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 08/30/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022] Open
Abstract
Superior vena cava syndrome results from the obstruction of blood flow through the superior vena cava and is most often due to thoracic malignancy. However, benign etiologies are on the rise secondary to more frequent use of intravascular devices such as central venous catheters and pacemakers. Although rarely a medical emergency, the symptoms can be alarming, particularly to the patient. Traditionally, superior vena cava syndrome has been managed with radiotherapy and chemotherapy. But interventional endovascular techniques have made inroads that offer a safe, rapid, and durable response. In many cases, it may be the only reasonable treatment. Because of this, an approach to endovascular treatment of this condition must be in the armamentarium of the interventional radiologist. This review will provide the reader with an insight into the etiology, pathophysiology, and various management principles of superior vena cava syndrome. The focus will be on understanding the techniques used during various endovascular interventions, including angioplasty, stenting, and pharmacomechanical thrombolysis. Discussion will also be centred on possible complications and current evidence as well as controversies regarding these approaches.
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Affiliation(s)
- Vamsidhar Rachapalli
- McGill University Health Centre, Royal Victoria Hospital, Department of Diagnostic Imaging - Division of Interventional Radiology, Montreal, Quebec, Canada
| | - Louis-Martin Boucher
- McGill University Health Centre, Royal Victoria Hospital, Department of Diagnostic Imaging - Division of Interventional Radiology, Montreal, Quebec, Canada
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24
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Iafrati M, Maloney S, Halin N. Radiofrequency thermal wire is a useful adjunct to treat chronic central venous occlusions. J Vasc Surg 2012; 55:603-6. [DOI: 10.1016/j.jvs.2011.09.090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/20/2011] [Accepted: 09/26/2011] [Indexed: 10/15/2022]
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Vernick WJ, Oware A. Early Diagnosis of Superior Vena Cava Obstruction Facilitated by the Use of Cerebral Oximetry. J Cardiothorac Vasc Anesth 2011; 25:1101-3. [DOI: 10.1053/j.jvca.2010.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE We describe the endovascular management of an 8-wk-old previously healthy female who developed superior vena cava syndrome secondary to Pseudomonas septic shock and disseminated intravascular coagulation. Doppler ultrasound confirmed near-total thrombotic occlusion of the superior vena cava and right internal jugular vein. She was taken emergently for cardiac catheterization, which confirmed the large superior vena cava thrombus extending into the right internal jugular vein and innominate vein with almost complete occlusion of the innominate vein. The superior vena cava to right atrium gradient was 14 mm Hg with very little antegrade flow into the right atrium, right femoral artery occlusion, and branch pulmonary artery emboli. Intervention involved serial balloon dilation inflations across the superior vena cava and innominate vein with improvement in the superior vena cava to right atrium gradient to 5 mm Hg and significant improvement in left ventricular function. Anticoagulation included heparin infusion for 48 hrs followed by enoxaparin for 1 month, alteplase for 48 hrs, eptifibatide (glycoprotein IIb/IIIa inhibitor) for 9 days followed by aspirin. DATA SOURCES Chart review. Case reports are exempt from approval of our Institutional Review Board. STUDY SELECTION None. DATA EXTRACTION None. DATA SYNTHESIS None. CONCLUSIONS Daily head ultrasounds were performed without evidence of intracranial hemorrhage. All thromboses resolved within 3 wks. Her organ function recovered and she was discharged to home. The etiology of her colitis is still unknown. At 9-month follow-up, she was doing well with no residual organ dysfunction.
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Szerlip M, Singh G, Luft UC. A case of a bloated face: SVC syndrome relieved by an endovascular approach. J Interv Cardiol 2011; 25:78-81. [PMID: 21599752 DOI: 10.1111/j.1540-8183.2011.00660.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Superior vena cava (SVC) syndrome, or obstruction of blood returning from the head and upper extremities, is a syndrome that is rapidly increasing in the cardiovascular patient population due to the increasing use of transvenous devices such as permanent pacemakers, implantable cardioverter defibrillators (ICDs), and indwelling venous access devices for hemodialysis. This syndrome in the past has been seen predominately in the cancer population with malignancy being the most common reason for SVC syndrome. The management of this syndrome has largely been with a medical/supportive care approach or with surgical bypass. Given the advancement in the field of endovascular interventions and the increasing expertise in performing these procedures, an endovascular approach to relieving the SVC obstruction is rapidly becoming the treatment of choice for these patients. We describe a case of a patient who had a chronic indwelling port-a-cath who developed SVC syndrome, which was treated with an endovascular approach with stenting of the SVC/brachiocephalic vein junction.
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Affiliation(s)
- Molly Szerlip
- University of Arizona, Sarver Heart Center, Tucson, Arizona 85724, USA.
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Superior vena caval stenting for idiopathic mediastinal fibrosis. Cardiovasc Interv Ther 2011; 26:260-2. [DOI: 10.1007/s12928-011-0062-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 03/06/2011] [Indexed: 10/18/2022]
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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; 123:1391-9. [PMID: 21422386 DOI: 10.1161/circulationaha.110.949180] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fibrosing Mediastinitis (FM) is a rare complication of infection with Histoplasma capsulatum that can lead to obstruction of pulmonary and systemic vasculature and large airways, often resulting in significant morbidity and mortality. Medical therapy is ineffective, and surgical intervention is often not feasible. Stent implantation offers a potential treatment for vascular obstruction due to FM, but this has not been well studied. METHODS AND RESULTS We conducted a retrospective review of all patients undergoing cardiac catheterization for FM. Anatomic site of stenosis and hemodynamic information before and after intervention, as well as clinical presentation and follow-up data, were recorded. From 1996 to 2008, 58 patients underwent cardiac catheterization for FM, with intervention performed in 40 (69%). A total of 77 stents were used to relieve 59 lesions (pulmonary artery=26, pulmonary vein=21, and superior vena cava=12). Significant reduction in pressure gradients (P<0.001) and increase in vessel caliber (P<0.001) were seen at all locations. Symptomatic recurrent stenosis requiring further intervention occurred in 11 patients (28%). Median time to recurrence was 115 months. Thirty-two (87%) of 37 patients for whom follow-up was available reported symptomatic improvement after stent placement. PROCEDURE related complications occurred in 14 patients (24%). Overall mortality was 19%, with the majority of deaths in patients with bilateral disease. Among patients with bilateral disease, intervention was associated with improved survival at 5 years. CONCLUSION Percutaneous vascular stent implantation is an effective therapy for central vascular obstruction due to FM, providing significant relief of anatomic obstruction and sustained clinical improvement.
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Affiliation(s)
- Erin L Albers
- Vanderbilt University Medical Center, Division of Pediatric Cardiology, 2200 Children's Way, Ste 5230, Nashville, TN 37232-6602, USA.
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Lauten A, Strauch J, Jung C, Goebel B, Krizanic F, Baer FM. Endovascular Treatment of Superior Vena Cava Syndrome by Percutaneous Venoplasty. Heart Lung Circ 2010; 19:681-3. [DOI: 10.1016/j.hlc.2010.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 03/24/2010] [Accepted: 07/08/2010] [Indexed: 11/27/2022]
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RILEY ROBERTF, PETERSEN STEFFENE, FERGUSON JOHND, BASHIR YAVER. Managing Superior Vena Cava Syndrome as a Complication of Pacemaker Implantation: A Pooled Analysis of Clinical Practice. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:420-5. [DOI: 10.1111/j.1540-8159.2009.02613.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ganeshan A, Quen Hon L, Warakaulle DR, Morgan R, Uberoi R. Superior vena caval stenting for SVC obstruction: Current status. Eur J Radiol 2009; 71:343-9. [DOI: 10.1016/j.ejrad.2008.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 04/15/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
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Barshes NR, Annambhotla S, El Sayed HF, Huynh TT, Kougias P, Dardik A, Lin PH. Percutaneous stenting of superior vena cava syndrome: treatment outcome in patients with benign and malignant etiology. Vascular 2008; 15:314-21. [PMID: 17976332 DOI: 10.2310/6670.2007.00067] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Symptomatic obstruction of the superior vena cava (SVC) can be caused by either intrathoracic malignancy or nonmalignant etiology resulting in superior vena cava syndrome (SVCS). The objective of this study was to evaluate the clinical outcome of percutaneous stenting of SVCS in patients with malignant and benign disease. During a 9-year period, 56 patients with SVCS underwent percutaneous stenting placement. Among them, malignant and benign disease was responsible for 40 patients (71%) and 16 patients (29%), respectively. The Wallstent was the most commonly used stent and was used in 45 patients (80%), whereas the Palmaz stent was used in 6 patients (11%). In 38 patients (68%), a single stent was deployed to treat an SVC lesion. In contrast, bilateral kissing stents were deployed in 9 patients (16%), which extended from bilateral brachiocephalic veins to the proximal SVC. Technical success was achieved in all patients while symptomatic improvement was noted in 54 patients (96%). No procedural complications occurred in this series. Primary patency in malignant and benign cases at 1 year was 64% and 76%, respectively. Overall symptom-free survival ranged from 1 to 34 months. Our study showed that endovascular treatment with percutaneous stenting provides an effective treatment strategy in patients with SVCS caused by either malignant or benign disease.
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Affiliation(s)
- Neal R Barshes
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
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Endovascular stenting for the management of port-a-cath associated superior vena cava syndrome. Emerg Radiol 2008; 16:143-6. [PMID: 18322718 DOI: 10.1007/s10140-008-0714-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 02/14/2008] [Indexed: 10/22/2022]
Abstract
Port-a-cath systems are often essential for the administration of long-term chemotherapy in the treatment of malignancies because they improve venous access, but they are associated with complications, mainly thrombosis of central veins. In the present report, we describe a case of right subclavian and superior vena cava port-a-cath-related thrombosis causing superior vena cava syndrome (SVCS) in a patient affected by Hodgkin's disease. The patient underwent percutaneous revascularization with stent positioning, experiencing immediate relief of symptoms. Endovascular procedures for the treatment of nonmalignant SVCS seem to represent a challenging therapeutic option.
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Rizvi AZ, Kalra M, Bjarnason H, Bower TC, Schleck C, Gloviczki P. Benign superior vena cava syndrome: Stenting is now the first line of treatment. J Vasc Surg 2008; 47:372-80. [DOI: 10.1016/j.jvs.2007.09.071] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/11/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
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García-Delgado M, Navarrete-Sánchez I, Colmenero M, Lara-Torrano J, Moyano-Calvente S, Garcia-Entrena A, Rodríguez-Elvira M. Superior Vena Cava Syndrome After Cardiac Surgery: Early Treatment by Percutaneous Stenting. J Cardiothorac Vasc Anesth 2007; 21:417-9. [PMID: 17544898 DOI: 10.1053/j.jvca.2006.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Indexed: 11/11/2022]
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Nicolae MI, Radford DJ, Slaughter RE. Stenting for superior caval vein stenosis after surgical repair of sinus venosus atrial septal defect. Heart Lung Circ 2006; 15:386-8. [PMID: 16934526 DOI: 10.1016/j.hlc.2006.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 05/18/2006] [Indexed: 11/23/2022]
Abstract
A young woman had symptoms from stenosis of the superior caval vein 8 years after surgical repair of sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage. She was successfully treated by balloon dilatation and stenting.
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Affiliation(s)
- Mugur I Nicolae
- Department of Cardiology, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, Qld 4032, Australia.
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