Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome.
OBJECTIVE
Self-expandable metal stents were inserted in cancer patients with superior vena cava (SVC) syndrome to assess their effectiveness as a primary treatment for symptom relief.


METHODS
Between January 1993 and June 2008, Wallstent prostheses (n = 208) were inserted in 149 cancer patients (137 men, 12 women; median age, 65 years; age range, 44-84 years) diagnosed as having SVC syndrome. A single stent was sufficient to restore vessel patency in 102 patients, two stents in 36, three stents in 10, and four stents in one. Survival data were calculated using Kaplan-Meier curves and multivariate analysis using the Cox regression method.


RESULTS
Complete resolution of symptoms was achieved in 123 patients within 72 hours, partial resolution in 22 patients, and no response in only four patients. At follow-up, 30 complications were noted: 16 obstructions, four cases of thrombosis, one partial stent migration to the right atrium, two cases of incorrect stent placement, six stent "shortenings," and one case in which stent expansion was insufficient. All complications except two were successfully resolved by repeat stenting or by angioplasty. The median symptom-free survival was 6 months (range, 2 days-43 months). As of June 2008, eight patients were alive with patent stents.


CONCLUSIONS
The Wallstent vascular endoprosthesis is an effective initial treatment in patients with SVC syndrome of neoplastic origin: Morbidity and complications are minimal, and clinical relief of symptoms is very rapid. Because the clinical decision for subsequent elective chemotherapy or radiation therapy is not prejudiced, stenting is a very effective initial step in the overall palliative treatment of patients with SVC syndrome.
Lanciego
Carlos
C
Interventional Radiology Unit, Department of Radiology, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Avda. de Barber 30, 45004 Toledo, Spain. clanciego@eresmas.com
Pangua
Cristina
C
Chacón
Jose Ignacio
JI
Velasco
Javier
J
Boy
Rafael Cuena
RC
Viana
Antonio
A
Cerezo
Sara
S
García
Lorenzo García
LG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D055752:Small Cell Lung Carcinoma / Q000150:complications / Q000188:drug therapy; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014654:Vascular Patency