title: Clinical outcome after intrahepatic venous stent placement for malignant inferior vena cava syndrome.
abstract: We evaluated the clinical outcome of malignant inferior vena cava (IVC) syndrome after intrahepatic IVC stent placement by retrospective analysis of 50 consecutive patients (25 men, 25 women, age 32-83 years) with malignant IVC syndrome who were treated with intrahepatic stent placement. Gianturco-Rosch-Z (GRZ) stents (n = 45), and Wallstents (n = 5) were inserted. Clinical outcome was assessed from patients' records using a score based on leg swelling, scrotal/vulvar edema, ascites and anasarca before and after stent placement, as well as at last follow-up visit before death. Clinical follow-up was supplemented by duplex sonography in 36 patients. Inferior venocavography was performed in 5 patients prior to re- intervention. Follow-up time ranged from 1 to 932 days (mean 62 days). Mean pressure gradient in the IVC was reduced from 14 +/- 4.1 mmHg before to 2.9 +/- 3.2 mmHg after stent placement (p < 0.001). Four patients had stent occlusion, 2 of whom were successfully re-stented. Primary and secondary patency was 59% and 100%, respectively at 540 days. Immediate clinical data were available in 44 patients: 38 improved; 6 did not respond. Last follow-up visit data were available in 36 patients: 24 showed persistent symptom relief till death. All symptom scores were significantly improved after stent placement (p < 0.001) and with the exception of ascites, remained significantly improved (p < 0.05) until the last follow-up. Increased serum bilirubin was a common characteristic of clinical failures and recurrences. Intrahepatic IVC stent placement resulted in significant symptomatic relief in patients with malignant IVC syndrome. Palliation was effective even in patients with a very short life expectancy.
authors.affiliation: Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201-3098, USA. platanos@hol.gr
authors.forename: Elias N
authors.initials: EN
authors.lastname: Brountzos
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Binkert
authors.forename: Irene E
authors.initials: IE
authors.lastname: Panagiotou
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Petersen
authors.forename: Hans
authors.initials: H
authors.lastname: Timmermans
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lakin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003251:Constriction, Pathologic / Q000209:etiology / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D008102:Liver Circulation / Q000502:physiology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D010690:Phlebography; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013577:Syndrome; D016896:Treatment Outcome; D014463:Ultrasonography; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D014654:Vascular Patency / Q000502:physiology; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*