Endovascular treatment for superior vena cava occlusion or obstruction in a pediatric and young adult population: a 22-year experience.
OBJECTIVE
The purpose of this research was to investigate the causes and symptoms of superior vena cava (SVC) obstruction or occlusion and report on the long-term results of transcatheter therapy.


BACKGROUND
Information on transcatheter therapy for SVC obstruction is limited.


METHODS
Superior vena cava catheterization interventions between August 1984 and April 2006 were reviewed. Patients were divided into 2 subgroups depending on whether or not they had previously undergone congenital cardiac surgery.


RESULTS
Sixty-three patients with median age of 3.7 years (range 1 month to 42 years) and weight of 13.3 kg (range 3 to 114 kg) were treated. Fifty patients (79%) were symptomatic, although only 50% had symptoms suggestive of SVC obstruction. Superior vena cava syndrome was more common in the non-cardiac surgical group (52% vs. 10%, p = 0.001). The mean gradient and SVC diameter improved from 10.8 +/- 5.8 mm Hg to 2.6 +/- 2.2 mm Hg (p < 0.001) and 3.1 +/- 2.7 mm to 9.1 +/- 3.8 mm, respectively (p < 0.001). The obstruction was adequately relieved in all 36 patients receiving stents and in 21 of 27 patients (78%) who had balloon dilation alone. Complications occurred in 12 patients (19%), all of whom had previously undergone cardiac surgery; 10 of these patients were successfully treated in the catheterization laboratory. Freedom from re-intervention did not differ between patients undergoing balloon dilation or stent implantation, but was longer in patients age >5 years at the time of intervention.


CONCLUSIONS
Superior vena cava-related symptoms occur in only 50% of patients with hemodynamically significant SVC obstruction. Endovascular therapy is successful in relieving the stenosis and associated symptoms with good long-term results.
Tzifa
Aphrodite
A
Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Marshall
Audrey C
AC
McElhinney
Doff B
DB
Lock
James E
JE
Geggel
Robert L
RL
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001794:Blood Pressure; D001900:Boston / Q000453:epidemiology; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy; D002404:Catheterization / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D015607:Stents / Q000706:statistics & numerical data; D013479:Superior Vena Cava Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome