title: Malignant superior vena cava syndrome: a comparative cohort study of treatment with covered stents versus uncovered stents.
abstract: OBJECTIVE
  To evaluate outcomes of expanded polytetrafluoroethylene (ePTFE)-covered stents and compare them with outcomes of uncovered stents in patients with malignant superior vena cava (SVC) syndrome.
  
  
  METHODS
  This study was approved by the institutional review board and written informed consent was obtained. Thirty-seven consecutive patients (33 men, four women; mean age, 60.3 years; range, 35-81 years) who underwent ePTFE-covered stent placement for SVC syndrome were enrolled in a prospective study between January 2009 and September 2011. Their data were compared with retrospective data of 36 consecutive patients (31 men, five women; mean age, 62.3 years; range, 41-81 years) who underwent uncovered stent placement for SVC syndrome between January 2005 and December 2008. The causes of malignant SVC syndrome were squamous cell carcinoma (n = 27), adenocarcinoma (n = 25), small cell carcinoma (n = 15), thymic carcinoma (n = 3), invasive thymoma (n = 2), and breast cancer (n = 1). Stent patency and patient survival rates were calculated by using the Kaplan-Meier method, and groups were compared with the log-rank test.
  
  
  RESULTS
  Stent placement was technically successful in all patients. Complications did not occur in either group. Kaplan-Meier analysis revealed that covered stents had higher cumulative patency (97%, 94%, 94%, and 94% at 1, 3, 6, and 12 months, respectively) than uncovered stents (97%, 79%, 67%, and 48% at 1, 3, 6, and 12 months, respectively; P = .038). Clinical success rates did not significantly differ (P = .674), nor did patient survival (P = .549). Median survival in the covered stent group was 141 days (95% confidence interval: 81, 201 days) and 100 days in the uncovered stent group (95% confidence interval: 60, 140 days).
  
  
  CONCLUSIONS
  Endovascular placement of ePTFE-covered stents appeared to be a safe and effective method to treat patients with malignant SVC syndrome and seemed to be superior to uncovered stents in terms of stent patency.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. radgwon@amc.seoul.kr
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Gwon
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Jin Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*
chemical_list: D020099:Coated Materials, Biocompatible