Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement.
OBJECTIVE
To evaluate use of catheter-directed thrombolysis and/or endovascular stent placement to treat superior vena cava (SVC) syndrome.


METHODS
Fifty-nine consecutive patients with SVC syndrome were studied. The cause was underlying malignancy in 43 and benign disease in 16. All patients underwent bilateral upper-extremity venography. The SVC was occluded in 31 cases and stenosed in 28. Twenty-seven patients underwent catheter-directed thrombolysis; 51 underwent endovascular stent placement. Patency was defined in terms of absence of symptoms and signs of SVC syndrome.


RESULTS
Technical success was achieved in 56 of 59 patients (95%). Among 42 patients with underlying malignancy (mean follow-up, 7.0 months; range, 1-34 months), primary clinical patency was achieved in 33 (79%) and secondary clinical patency was achieved in 39 (93%). Among 13 patients with benign disease (mean follow-up, 17.0 months; range, 1-27 months), primary clinical patency was achieved in 10 (77%) and secondary clinical patency was achieved in 11 (85%). Four patients were lost to follow-up. Periprocedural mortality and morbidity rates were 3% (two of 59 patients) and 10% (six of 59 patients), respectively.


CONCLUSIONS
Catheter-directed thrombolysis and endovascular stent placement is a safe and effective treatment for SVC syndrome.
Kee
S T
ST
Department of Radiology, Stanford University Medical Center, CA 94305-5105, USA.
Kinoshita
L
L
Razavi
M K
MK
Nyman
U R
UR
Semba
C P
CP
Dake
M D
MD
D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use*; D015642:Radiology, Interventional; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014654:Vascular Patency
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator