Korean J Radiol.  2014 Feb;15(1):87-94. 10.3348/kjr.2014.15.1.87.

Covered Stent Placement for the Treatment of Malignant Superior Vena Cava Syndrome: Is Unilateral Covered Stenting Safe and Effective?

• Cho Y
• Gwon DI
• Ko GY
• Ko HK
• Kim JH
• Shin JH
• Yoon HK
• Sung KB

• KMID: 1711482
• DOI: http://doi.org/10.3348/kjr.2014.15.1.87

Abstract

OBJECTIVE
To evaluate the safety and efficacy of unilateral covered stent placement in patients with malignant superior vena cava (SVC) syndrome.
MATERIALS AND METHODS
Between October 2008 and November 2012, expanded polytetrafluoroethylene-covered stent placement for malignant SVC syndrome was performed in 40 consecutive patients (35 men and five women; mean age, 61.4 years; range, 35-81 years). All covered stents were unilaterally placed within the SVC or across the venous confluence when needed to relieve venous obstruction and prevent tumor overgrowth, regardless of patency of contralateral brachiocephalic veins.
RESULTS
Stent placement was technically successful in all patients. There were no major complications. Of the 37 patients symptomatic prior to stent placement, 34 (92%) experienced complete symptomatic relief 1-8 days after stent placement. Of the 29 patients who underwent covered stent placement across the venous confluence, nine patients had patent contralateral brachiocephalic veins prior to stent placement. However, no sign of SVC obstruction or contralateral upper extremity venous thrombosis was observed during the follow-up period. Kaplan-Meier analysis revealed median patient survival of 163 days. Stent occlusion occurred in four (10%) of 40 patents. Cumulative stent patency rates at 1, 3, 6, and 12 months were 95%, 92%, 86%, and 86%, respectively.
CONCLUSION
Unilateral covered stent placement appears to be a safe and effective method for treating malignant SVC syndrome, despite the location of SVC occlusion.

Keyword

Malignant superior vena cava syndrome; Covered stent

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
*Polytetrafluoroethylene
Retrospective Studies
*Stents/adverse effects
Superior Vena Cava Syndrome/etiology/mortality/*therapy
Treatment Outcome
Polytetrafluoroethylene

Figure

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  Fig. 1 52-year-old man with adenocarcinoma of lung that caused symptomatic SVC syndrome. A. Contrast-enhanced axial CT image shows bronchus-encasing mass and mediastinal lymphadenopathy, causing significant narrowing of right SVC (arrowhead). B. Axial CT scan at upper level of (A) shows patent flow of left brachiocephalic vein demonstrated by contrast enhancement (arrows). C. Right internal jugular venography shows severe stenosis at right SVC (arrowhead) with proximal venous contrast stasis. D. Venography obtained after ePTFE-covered stent placement (12 mm × 4 cm) (arrowheads) across SVC and venous confluence shows fluent passage of contrast medium via stent. E. Follow-up contrast-enhanced axial CT image at same level of (B) performed 2 months after stent placement shows obliterated left brachiocephalic vein (arrows). However, patient was free of any symptoms related to SVC or left upper extremity venous obstruction. SVC = superior vena cava, ePTFE = expanded poly tetrafluoroethylene

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  Fig. 2 Kaplan-Meier curve of survival rate of study patients.

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  Fig. 3 Kaplan-Meier curve of patency rate of study patients.

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