HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Lanciego, C. Articles by García, L. G. PubMed PubMed Citation Articles by Lanciego, C. Articles by García, L. G. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Endovascular Stenting as the First Step in the Overall Management of Malignant Superior Vena Cava Syndrome

¹ Interventional Radiology Unit, Department of Radiology, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Avda. de Barber 30, 45004 Toledo, Spain.
² Servicio de Oncología Médica, Complejo Hospitalario de Toledo, Toledo, Spain.
³ Unidad de Investigación-Estadística of the Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, Spain.
⁴ Servicios de Oncología Médica del Hospital de Talavera, Toledo, Spain.
⁵ Hospital La Mancha Centro-Alcázar de San Juán, Ciudad Real, Spain.

OBJECTIVE. Self-expandable metal stents were inserted in cancer patients with superior vena cava (SVC) syndrome to assess their effectiveness as a primary treatment for symptom relief.

SUBJECTS AND METHODS. Between January 1993 and June 2008, Wallstent prostheses (n = 208) were inserted in 149 cancer patients (137 men, 12 women; median age, 65 years; age range, 44-84 years) diagnosed as having SVC syndrome. A single stent was sufficient to restore vessel patency in 102 patients, two stents in 36, three stents in 10, and four stents in one. Survival data were calculated using Kaplan-Meier curves and multivariate analysis using the Cox regression method.

RESULTS. Complete resolution of symptoms was achieved in 123 patients within 72 hours, partial resolution in 22 patients, and no response in only four patients. At follow-up, 30 complications were noted: 16 obstructions, four cases of thrombosis, one partial stent migration to the right atrium, two cases of incorrect stent placement, six stent "shortenings," and one case in which stent expansion was insufficient. All complications except two were successfully resolved by repeat stenting or by angioplasty. The median symptom-free survival was 6 months (range, 2 days-43 months). As of June 2008, eight patients were alive with patent stents.

CONCLUSION. The Wallstent vascular endoprosthesis is an effective initial treatment in patients with SVC syndrome of neoplastic origin: Morbidity and complications are minimal, and clinical relief of symptoms is very rapid. Because the clinical decision for subsequent elective chemotherapy or radiation therapy is not prejudiced, stenting is a very effective initial step in the overall palliative treatment of patients with SVC syndrome.

Keywords: endovascular stenting • hemodynamics • lung cancer • oncologic imaging • stents • superior vena cava syndrome

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?