Interventional Treatment for Superior Vena Cava Syndrome with Malignant Causes / 中国微创外科杂志

ABSTRACT

Objective To evaluate the efficacy and clinical value of percutaneous transluminal angioplasty(PTA)with stenting for the treatment of superior vana cava syndrome(SVCS)with malignant causes.Methods A total of 13 patients with SVCS with malignant causes were enrolled in this study.Among the patients,2 had mediastinal cancer,and 11 had metastatic mediastinal tumor.The malignancy of the primary tumors of the 11 patients,including pulmonary cancer in 8,esophageal cancer in 2,and breast cancer in 1,were all confirmed by pathological examination.Via the right femoral vein,a pigtail catheter was introduced percutaneously into the proximate or remote end of the stenotic segment for the visualization of the SVC.After the location,length,and gravity of the stenosis were determined,Wallstent(Boston Scientific,USA)was placed into the SCV,if the patients had no local thrombosis in the stenotic segment.In one patient,a Z-shape stent(COOK,USA)was inserted simultaneously.For the cases complicated with thrombosis,the Wallstent was inserted after local thrombolysis.Results The procedure was completed in all the 13 patients with a success rate of 100%.The average length of the stenotic segment was 4.3 cm(3-6 cm).In one patient,two stents were used,while in the others only one stent was inserted.Thrombolysis was carried out before stenting in 6 patients.The intravenous pressure at the proximate end of the stenotic segment was determined with the patients supine before and after stenting.The pressure decreased from(26.2?1.6)cm H2O to(4.3?0.8)cm H2O after the operation.Postoperative angiography showed no collateral vein in the patients.The SCVS disappeared 0 to 3 days after the surgery.The patients were followed up for 8-26 months with a median of 13.During this period,8 patients died of multiple organ failure caused by multiple metastasis of the primary tumor in 4 to 10 months;the other 5 patients survived(3 of them received further therapies)without recurrence of SCVS.Conclusion PTA with stenting combined with local thrombosis is an effective and invasive treatment for patients with SCVS with malignant causes.