title: Isolated pharmacomechanical thrombolysis plus primary stenting in a single procedure to treat acute thrombotic superior vena cava syndrome.
abstract: OBJECTIVE
  To report a combined procedure that opens the acutely thrombosed superior vena cava (SVC) to rapidly alleviate symptoms in seriously ill patients with SVC syndrome.
  
  
  METHODS
  Four patients aged 54 to 63 years old with underlying malignancies were referred for treatment of SVC syndrome. All received isolated pharmacomechanical thrombolysis (IPMT) with tissue plasminogen activator delivered in a Trellis Peripheral Infusion System that removed obstructive clot in minutes versus the 24 to 48 hours required for traditional catheter-directed thrombolysis. In each case, stents were inserted immediately following IPMT in a combined procedure lasting <1 hour. Patients exhibited near-immediate relief of debilitating symptoms; completion venography demonstrated patent vessels with excellent blood flow.
  
  
  CONCLUSIONS
  Combining IPMT with immediate stenting during the same session is an effective method for managing acute thrombotic SVC syndrome and limiting the exposure time and number of interventions performed on seriously ill patients.
authors.affiliation: Section of Interventional Radiology, Department of Radiology, and, University College Hospital, Newcastle Road, Galway, Ireland. gerard.osullivan2@hse.ie
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: O'Sullivan
authors.forename: Jennifer Ni
authors.initials: JN
authors.lastname: Mhuircheartaigh
authors.forename: David
authors.initials: D
authors.lastname: Ferguson
authors.forename: Eithne
authors.initials: E
authors.lastname: Delappe
authors.forename: Conor
authors.initials: C
authors.lastname: O'Riordan
authors.forename: Ann Michelle
authors.initials: AM
authors.lastname: Browne
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation*; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic; D004487:Edema / Q000209:etiology / Q000628:therapy; D004867:Equipment Design; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010690:Phlebography; D012008:Recurrence; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017131:Thrombectomy / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000295:instrumentation; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010959:Tissue Plasminogen Activator