Endovascular Stenting as a First Choice for the Palliation of Superior Vena Cava Syndrome

To assess the effectiveness of endovascular stenting for the palliation of superior vena cava (SVC) syndrome, endovascular stent insertion was attempted in 10 patients with symptomatic occlusion of the SVC. All the patients had known malignant disease of the thorax. Eight patients had been treated previously with chemotherapy and radiotherapy (n=5), chemotherapy alone (n=2), or pneumonectomy and radiotherapy (n=1). After developing SVC syndrome, all the patients were stented before receiving any other treatment. After single or multiple endovascular stents were inserted, five of eight patients were treated with chemotherapy and radiotherapy (n=2) or chemotherapy alone (n=3). Resolution of symptoms was achieved in nine patients within 72 hr (90%). In one patient, the symptoms did not disappear until a second intervention. At follow up, symptoms had recurred in two of ten patients (20%) after intervals of 15 and 60 days. Five patients have died from their cancers, although they remained free of symptoms of SVC occlusion until death. In conclusion, endovascular stent insertion is an effective treatment for palliation of SVC syndrome. Endovascular stent insertion can be considered the first choice of treatment, due to the immediate relief of symptoms and excellent sustained symptomatic relief.

Transcatheter Embolization in Patients with Massive Upper Gastrointestinal Hemorrhage

Angiography and transcatheter embolization were performed in 12 patients with massive UGI bleeding from March 1990 to Feburuary 1996. These patients were all men of a mean age of 46 years (range, 33~76 years). Causes of bleeding were duodenal ulcer(5 cases), pseudoaneurysm(3 cases) due to chronic pancreatitis, hemobilia(2 cases) due to trauma, gastric mucosal injury(1 case) due to drug ingestion. Celiac arteriography and superior mesenteric arteriography were performed. Embolization was done in 12 patients. Embolic agents were steel coils. Eleven patients show an extravasaton of contrast media on angiography. In one patient who shows no extravasation, an pseudoaneurysm in gastroduodenal artery was found. Sources of bleeding were gastroduodenal artery(8), right hepatic artery(2), left hepatic artery(1), and left gastric artery(1). Bleeding was successfully controlled in all 12 patients. Two patients, however, rebled and an operation was performed. In one patient with pseudoaneurysm, bleeding recurred 13 days after embolization. This patient underwent second embolotherapy and operation 14 days later. There were no complication related to the procedure. Angiographic localization and transcatheter embolization can be an safe and effective treatment for massive UGI hemorrhage, especially in patients considered poor candidate for operation.

The Usefulness of Three-Dimensional Spiral CT Angiography in the Evaluation of Atherosclerotic Diseases Involving the Arteries of the Lower Extremity

PURPOSE: To assess the usefulness of three-dimensional spiral CT angiography in the diagnosis and as a guide for the treatment of arteriosclerosis obliterans of the lower extremity. MATERIALS AND METHODS: During a recent one-year period, CTA and conventional angiography were performed in 12 patients with suspected ASO. From the upper margin of the third lumbar vertebral body to below the knee joint, helical CT scanning was performed 30-45 seconds after the injection of Ultravist 370(150-180ml) by a power injector at the rate of 2.5-3.0ml/sec via the antecubital vein. The resulting data were reformatted by SSD after reconstruction of 5mm intervals, and CTA was compared with CA for site and degree of stenotic or occlusive lesion. RESULTS: On CTA and CA, twenty-three occlusive lesions above the tibioperoneal artery were detected in 12 patients. On CA, three mild seven moderate and eight severe stenoses were seen, as well as five occlusions. There were three cases of overgrading and three of undergrading. Overall diagnostic accuracy was 73.9%(17/23). Calcifications were detected at on axial CT scanning in the two of three underestimated lesions. Migration of the thrombi was noted in one case. CONCLUSION: CTA may be useful in the evaluation of the arteries of the lower extremities, and valuable in the planning and follow-up of treatment.