title: A Review of Open and Endovascular Treatment of Superior Vena Cava Syndrome of Benign Aetiology.
abstract: BACKGROUND
  The widespread use of central venous catheters, ports, pacemakers, and defibrillators has increased the incidence of benign superior vena cava syndrome (SVCS). This study aimed at reviewing the results of open and endovascular treatment of SVCS.
  
  
  METHODS
  Medical literature databases were searched for relevant studies. Studies with more than five adult patients, reporting separate results for the SVC were included. Nine studies reported the results of endovascular treatment of SVCS including 136 patients followed up for a mean of 11-48 months. Causes of SVCS were central venous catheters and pacemakers (80.6%), mediastinal fibrosis (13.7%), and other (5.6%). Percutaneous transluminal angioplasty (PTA) and stenting was performed in 73.6%, PTA only in 17.3%, and thrombolysis, PTA, and stenting in 9%. Four studies reported the results of open repair of SVCS including 87 patients followed up between 30 months and 10.9 years. The causes were mediastinal fibrosis (58.4%), catheters and pacemakers (28.5%), and other (13%). Operations performed included a spiral saphenous interposition graft, other vein graft, PTFE graft, and human allograft. Thirteen patients required re-operations (15%) before discharge mainly for graft thrombosis.
  
  
  RESULTS
  In the endovascular group technical success was 95.6%. Thirty day mortality was 0%. Regression of symptoms was reported in 97.3%. Thirty-two patients (26.9%) underwent 58 secondary procedures. In the open group the 30 day mortality was 0%. Symptom regression was reported in 93.5%. Twenty-four patients (28.4%) underwent a total of 33 secondary procedures.
  
  
  CONCLUSIONS
  Endovascular is the first line treatment for SVCS caused by intravenous devices, whereas surgery is most often performed for mediastinal fibrosis. Both treatments show good results regarding regression of the symptoms and mid-term primary patency, with a significant incidence of secondary interventions.
authors.affiliation: Department of Vascular Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece. Electronic address: gsfyr@yahoo.gr.
authors.forename: G S
authors.initials: GS
authors.lastname: Sfyroeras
authors.affiliation: Department of Vascular Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: C N
authors.initials: CN
authors.lastname: Antonopoulos
authors.affiliation: Department of Vascular Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Mantas
authors.affiliation: Department of Vascular Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: K G
authors.initials: KG
authors.lastname: Moulakakis
authors.affiliation: Department of Vascular Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: J D
authors.initials: JD
authors.lastname: Kakisis
authors.affiliation: 2nd Laboratory of Radiology, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Brountzos
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Lattimer
authors.affiliation: Department of Vascular Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece; Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Geroulakos
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Endovascular treatment; Obstruction; Superior vena cava syndrome; Surgical treatment; Thrombosis