Technical and Anatomic Factors Influencing the Success of Inferior Vena Caval Stent Placement for Malignant Obstruction.
OBJECTIVE
To evaluate the outcomes of inferior vena cava (IVC) stent placement for malignant obstruction and to identify anatomic and procedural factors influencing technical and clinical success.


METHODS
A total of 57 patients (37 male, 20 female; age range, 22-86 y) underwent 62 IVC stent placement procedures using 97 stents (47 Wallstents, 15 S.M.A.R.T. stents, 18 Wallflex stents, 17 others) from 2005 to 2016 for malignant IVC obstruction caused by hepatic metastases (n = 22; 39%), primary hepatic malignancy (n = 16; 28%), retroperitoneal metastases (n = 16; 28%), or other primary malignancy (n = 5; 9%). Presenting symptoms included lower-extremity edema (n = 54; 95%), ascites (n = 28; 50%), and perineal edema (n = 14; 25%). Sixteen percent (n = 10) and 10% (n = 6) of the procedures involved tumor and bland thrombus, respectively.


RESULTS
Stent placements resulted in 100% venographic patency and significantly decreased pressure gradients (P < .0001). Lower-extremity swelling, perineal swelling, and abdominal distension improved within 7 days in 83% (35 of 42), 100% (9 of 9), and 40% (6 of 15) of patients, respectively, and at 30 days after the procedure in 86% (25 of 29), 89% (8 of 9), and 80% (4 of 5) of patients, respectively. Increased pre- and post-stent placement pressure gradients were associated with worse outcomes. A 4% stent misplacement rate (4 of 97) was related to the use of Wallstents with caudal stent tapering, asymmetric deployment superior to the obstruction, suprahepatic IVC involvement, and decreased stent adherence to the IVC wall as a result of local mechanical factors.


CONCLUSIONS
Stent placement is reliable, rapid, and durable in improving malignant IVC syndrome. Understanding of technical and anatomic factors can improve accuracy and avoid complications of stent misplacement.
Division of Interventional Radiology, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305.
Zlatko
Z
Devcic
Division of Interventional Radiology, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305.
Tust
T
Techasith
Division of Interventional Radiology, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305.
Arjun
A
Banerjee
Radiology Sciences Laboratory, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305.
Jarrett K
JK
Rosenberg
Division of Interventional Radiology, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305. Electronic address: dansze@stanford.edu.
Daniel Y
DY
Sze
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology; D003251:Constriction, Pathologic; D004487:Edema / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D010166:Palliative Care; D010690:Phlebography; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult