Stenting as first option for endovascular treatment of malignant superior vena cava syndrome.
OBJECTIVE
Endoprostheses were inserted in cancer patients with superior vena cava syndrome to assess their effectiveness as first-choice, initial treatment for relief of symptoms.


METHODS
Wallstent prostheses (n = 73) of various lengths (5-14 cm; median, 7 cm) and diameters (10-16 mm; median, 16 mm) were inserted in 52 cancer patients (51 men, 1 woman; age range, 44-78 years; mean, 63 years) who were diagnosed and confirmed by cavography or phlebography as having superior vena cava syndrome. A single stent was sufficient in 37 patients, two stents were required in 11, three stents in two, and four stents in another two patients. Contraindications for the procedure were severe cardiopathy or coagulopathy.


RESULTS
Resolution of symptoms was achieved in all patients within 72 hr. At follow-up, six obstructions, one partial migration to the right atrium, two incorrect placements, and four stent "shortenings" were noted. All were successfully resolved by repeated stenting. Symptom-free survival ranged from 2 days to 17 months (mean, 6.4 months). At the time of this writing, eight patients are alive and have patent stents. The rest have died from their cancer.


CONCLUSIONS
The Wallstent vascular endoprosthesis is an effective initial treatment in superior vena cava syndrome of neoplastic origin. Morbidity and complications are minimal. Clinical relief of symptoms is rapid; therefore, the Wallstent endoprosthesis is highly recommended as the first choice for palliative treatment of superior vena cava syndrome, especially because the clinical decision for subsequent chemotherapy or radiotherapy or surgery is not in any way prejudiced.
Lanciego
C
C
Unidad de Radiología Vascular-Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Avda. de Barber s/n, 45004 Toledo, Spain.
Chacón
J L
JL
Julián
A
A
Andrade
J
J
López
L
L
Martinez
B
B
Cruz
M
M
García-García
L
L
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000000981:diagnostic imaging; D018288:Carcinoma, Small Cell / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary; D008654:Mesothelioma / Q000000981:diagnostic imaging / Q000628:therapy; D008875:Middle Aged; D010690:Phlebography; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D013899:Thoracic Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging