title: Endovascular treatment of malignant superior vena cava syndrome: results and predictive factors of clinical efficacy.
abstract: OBJECTIVE
  To demonstrate the effectiveness of endovascular treatment (EVT) with self-expandable bare stents for malignant superior vena cava syndrome (SVCS) and to analyze predictive factors of EVT efficacy.
  
  
  METHODS
  Retrospective review of the 164 patients with malignant SVCS treated with EVT in our hospital from August 1992 to December 2007 and followed until February 2009. Endovascular treatment includes angioplasty before and after stent placement. We used self-expandable bare stents. We studied results of this treatment and looked for predictive factors of clinical efficacy, recurrence, and complications by statistical analysis.
  
  
  RESULTS
  Endovascular treatment was clinically successful in 95% of cases, with an acceptable rate of early mortality (2.4%). Thrombosis of the superior vena cava was the only independent factor for EVT failure. The use of stents over 16 mm in diameter was a predictive factor for complications (P = 0.008). Twenty-one complications (12.8%) occurred during the follow-up period. Relapse occurred in 36 patients (21.9%), with effective restenting in 75% of cases. Recurrence of SVCS was significantly increased in cases of occlusion (P = 0.01), initial associated thrombosis (P = 0.006), or use of steel stents (P = 0.004). Long-term anticoagulant therapy did not influence the risk of recurrence or complications.
  
  
  CONCLUSIONS
  In malignancy, EVT with self-expandable bare stents is an effective SVCS therapy. These results prompt us to propose treatment with stents earlier in the clinical course of patients with SVCS and to avoid dilatation greater than 16 mm.
authors.affiliation: Clinique universitaire de médecine interne, Pôle Pluridisciplinaire de Médecine, CHU de Grenoble, Grenoble, France. DFagedet@chu-grenoble.fr
authors.forename: Dorothée
authors.initials: D
authors.lastname: Fagedet
authors.forename: Frederic
authors.initials: F
authors.lastname: Thony
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Mathieu
authors.initials: M
authors.lastname: Rodiere
authors.forename: Valérie
authors.initials: V
authors.lastname: Monnin-Bares
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Ferretti
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: Denis
authors.initials: D
authors.lastname: Moro-Sibilot
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome