Superior Vena Cava Syndrome and Wallstent: A Systematic Review

Clinical outcomes of endovascular treatment in hemodialysis patients with central venous stenosis: A retrospective analysis

INTRODUCTION

Endovascular treatment is one of treatment options for hemodialysis patients with central venous stenosis (CVS), but clinical outcomes and risk factors remain inadequately studied. This study seeks to investigate the occurrence and risk factors associated with CVS.

METHODS

This retrospective study analyzed the distribution and causes of 385 lesions in 309 hemodialysis patients with symptomatic CVS. We particularly examined patients with single-segment lesions treated with endovascular treatment to explore patency rates and related factors.

RESULTS

The proportion of catheter-related superior vena cava (SVC) lesions was 100%. In the subgroup of single-segment lesions (from 205 patients) 187 patients successfully treated with endovascular treatment (technical success was 91.22%) and Cox analysis revealed that age over 50 years (HR = 2.057, 95% CI: 1.174-3.603, p = 0.012), upper-arm arteriovenous fistula (HR = 1.832, 95% CI: 1.127-2.977, p = 0.015), and presence of preoperative collateral circulation (HR = 1.924, 95% CI: 1.241-2.982, p = 0.003) were prognostic factors influencing the 1-year primary patency rate of subclavian veins, while age over 50 years (HR = 3.618, 95% CI: 1.465-8.933, p = 0.005), upper-arm arteriovenous fistula (HR = 1.972, 95% CI: 1.116-3.482, p = 0.019), high pressure to efface waist at the stenotic site (HR = 2.343, 95% CI: 1.106-4.961, p = 0.026), and diabetes (HR = 1.953, 95% CI: 1.042-3.661, p = 0.037) were prognostic factors for brachiocephalic veins. Due to the small sample size, comprehensive analysis of risk factors for restenosis could not be performed.

CONCLUSION

Central venous balloon angioplasty is an effective treatment for central venous stenosis in hemodialysis patients, with satisfactory technical and clinical success rates. Age, upper arm fistula and collateral circulation are important factors affecting the treatment outcome for subclavian veins. Similarly, the corresponding factors for the brachiocephalic veins include age, upper-arm fistula, high pressure to efface waist and diabetes.

Characteristics and percutaneous transluminal angioplasty treatment outcomes of superior vena cava obstruction in patients undergoing hemodialysis

BACKGROUND

This study aimed to investigate the clinical outcomes of percutaneous transluminal angioplasty (PTA) in patients undergoing hemodialysis with different types of superior vena cava obstruction (SVCO) lesions.

METHODS

This retrospective observational study recruited patients undergoing hemodialysis with SVCO and analyzed the clinical characteristics of SVCO. Patency rates were collected for patients treated with PTA and were assessed using the t-test, U-test, log-rank test and survival analyses such as the Kaplan-Meier method.

RESULTS

A total of 49 patients undergoing hemodialysis with SVCO were classified as type I (N.=17), type II (N.=7), type III (N.=15) and type IV (N.=10). All patients had a history of catheter placement. There were 14 cases of SVCO-related catheter dysfunction, and PTA was performed in 35 patients with a technical success rate of 77.14% (27/35). Failures were observed exclusively in eight patients with type III or IV lesions. The median follow-up was 15 (1.5-58) months, with 6- and 12-month post-PTA primary patency rates of 51.9% and 14.4%, respectively. The primary assisted patency rates were 70.2% and 55.2%, and the secondary patency rates were 92.6% and 78.0%, requiring 2.68 PTAs per patient per year to maintain them. Type I-II lesions demonstrated significantly higher primary patency and primary assisted patency rates than type III-IV lesions (P=0.007 and P=0.002).

CONCLUSIONS

Percutaneous transluminal angioplasty may be used to treat type I or II SVCO, achieving high technical success and patency rates. Patients undergoing hemodialysis with SVCO may have a condition related more to catheter placement than to arteriovenous fistula.

Safety and Effectiveness of Abre Self-Expanding Venous Stent for Treatment of Superior Vena Cava Syndrome

PURPOSE

Superior vena cava (SVC) syndrome is a constellation of symptoms that results from partial or complete SVC obstruction. Endovascular SVC stenting is an effective treatment for SVC syndrome with rapid clinical efficacy and low risk of complications. In this study, we assess the technical and clinical outcomes of a cohort of patients with SVC syndrome treated with the AbreTM self-expanding venous stent (Medtronic, Inc, Minneapolis, MN, USA).

METHODS

An institutional database was used to retrospectively identify patients with SVC syndrome treated with AbreTM venous self-expanding stent placement between 2021-2023. Patient demographic data, technical outcomes, treatment effectiveness, and adverse events were obtained from the electronic medical record. Nineteen patients (mean age 58.6) were included in the study. Thirteen interventions were performed for malignant compression of the SVC, 5 for central venous catheter-related SVC stenosis, and 1 for HD fistula-related SVC stenosis refractory to angioplasty.

RESULTS

Primary patency was achieved in 93% of patients (17/19). Two patients (7%) required re-intervention with thrombolysis and angioplasty within 30 days post-stenting. Mean duration of clinical and imaging follow-up were 228.7 ± 52.7 and 258.7 ± 62.1 days, respectively. All patients with clinical follow-up experienced significant improvement in clinical symptoms post-intervention. No stent related complications were identified post-intervention.

CONCLUSIONS

Treatment of SVC syndrome with the AbreTM self-expanding venous stent has high rates of technical and clinical success. No complications related to stent placement were identified in this study.

The difficulties of recanalization in chronic superior cava vein obstruction by penetrating diagnostic catheter, PTA, and stenting: A case report

Superior vena cava obstruction is caused by a blockage in its blood flow; one of its few causes can be device related. This case follows a patient presented with superior vena cava obstruction following a septal cardiac implant. Endovascular intervention has been associated with more rapid, complete symptom relief and lower complication rates. The use of stenting as first-line therapy has gathered popularity to become standard practice in the past 2 decades. This paper illustrates a successful recanalization with penetrating diagnostic catheter, followed with percutaneous transluminal angioplasty stenting in order to preserve the patency superior vena cava.

[Non-infectious respiratory emergencies in patients with cancer]

Patients with a solid tumor or hematologic malignancy are often addressed to emergency units for an acute respiratory complication associated with the underlying cancer or secondary to treatments. The current article is part of a thematic series: "Intensive care and emergencies in solid tumours and blood cancer patients" and will develop the following points: (1) malignant proximal airway obstruction and, more specifically, the role of therapeutic bronchoscopy; (2) superior vena cava syndrome by tumor compression and/or secondary to thrombosis (diagnosis, local and systemic treatments); (3) cancer-related pulmonary embolism (incidence, indications for low-molecular weight heparins and direct oral anticoagulants). Other respiratory emergencies will be dealt in the other articles of this series.

Interventions for superior vena cava syndrome

Superior vena cava (SVC) syndrome refers to the clinical manifestations of cerebral venous hypertension secondary to obstruction of the SVC and/or the innominate veins. The most common cause of SVC syndrome is malignancy like small cell lung cancer and non-Hodgkin lymphoma, but there is an increasing trend of benign etiologies secondary to thrombosis due to central lines/ pacemakers or mediastinal fibrosis. Supportive measures include head elevation, diuresis, supplemental oxygen, and steroids. Thrombolysis with or without endovenous stenting is required emergently in those with airway compromise or symptoms secondary to cerebral edema. Definitive treatment in those with malignancy is multidisciplinary; this requires radiotherapy, chemotherapy, SVC stenting, oncologic surgery and SVC bypass or reconstruction. Endovascular treatment is the primary modality for palliation in malignancy and in those with benign etiology. Surgery is reserved for those who have failed or are unsuitable for endovascular treatment. In patients with benign disease endovenous stenting and open surgery provide excellent symptom relief and are safe and effective.