Stenting as First Option for Endovascular Treatment of Malignant Superior Vena Cava Syndrome
C. Lanciego1,
J. L. Chacón2,
A. Julián2,
J. Andrade2,
L. López2,
B. Martinez2,
M. Cruz2 and
L. García-García1
1
Unidad de Radiología
Vascular-Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario
de Toledo, Avda. de Barber s/n, 45004 Toledo, Spain.
2
Servicio de Oncología
Médica, Hospital Virgen de la Salud, Toledo,
Complejo Hospitalario de Toledo, 45004 Toledo, Spain.
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Fig. 1A. —68-year-old man with small cell carcinoma and occlusion of
both brachiocephalic veins that resulted in severe superior vena cava
syndrome. Patient underwent implantation of two Wallstents (Boston Scientific,
Schneider Europe, Bulach, Switzerland), one on each side, in tandem technique.
Superior venacavagram shows obstruction of both innominate venous trunks and
development of collateral network from neck veins.
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Fig. 1B. —68-year-old man with small cell carcinoma and occlusion of
both brachiocephalic veins that resulted in severe superior vena cava
syndrome. Patient underwent implantation of two Wallstents (Boston Scientific,
Schneider Europe, Bulach, Switzerland), one on each side, in tandem technique.
Final superior venacavagram obtained after bilateral stent placement shows
disappearance of collateral venous network.
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Fig. 2A. —72-year-old man with non—small cell lung carcinoma and
progressive superior vena cava syndrome due to severe stenosis. Superior
venacavagram before endovascular treatment shows severe stenosis of vena cava
and confluence of right innominate vein. Note collateral venous network from
thoracic, neck, and azygos veins.
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Fig. 2B. —72-year-old man with non—small cell lung carcinoma and
progressive superior vena cava syndrome due to severe stenosis. Venacavagram
after placement of Wallstent (Boston Scientific, Schneider Europe, Bulach,
Switzerland) vascular endoprosthesis (16 mm diameter x 6 cm length) in
right innominate vein and superior vena cava shows disappearance of venous
network.
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Fig. 2C. —72-year-old man with non—small cell lung carcinoma and
progressive superior vena cava syndrome due to severe stenosis. Clinical
appearance of patient with superior vena cava syndrome before stenting. Note
swelling of face, neck, and upper thorax.
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Fig. 2D. —72-year-old man with non—small cell lung carcinoma and
progressive superior vena cava syndrome due to severe stenosis. Same patient
48 hr after stenting.
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Fig. 3A. —67-year-old man with occlusion of superior vena cava due to
non—small cell lung carcinoma in whom (as is routine in all cases) we
used specialized software to measure both degree and extent of stenosis. This
knowledge helps in making correct choice of prosthesis. Superior venacavagram
shows stenosis of vena cava and prominent collateral venous network.
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Fig. 3B. —67-year-old man with occlusion of superior vena cava due to
non—small cell lung carcinoma in whom (as is routine in all cases) we
used specialized software to measure both degree and extent of stenosis. This
knowledge helps in making correct choice of prosthesis. Venacavagram after
placement of Wallstent (Boston Scientific, Schneider Europe, Bulach,
Switzerland) shows vessel reopening and resolution of vena cava stenosis.
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Fig. 3C. —67-year-old man with occlusion of superior vena cava due to
non—small cell lung carcinoma in whom (as is routine in all cases) we
used specialized software to measure both degree and extent of stenosis. This
knowledge helps in making correct choice of prosthesis. Marks and diagrams
show measurement of stenosis in A (length, diameter, and stenosed area)
using dedicated software.
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Fig. 3D. —67-year-old man with occlusion of superior vena cava due to
non—small cell lung carcinoma in whom (as is routine in all cases) we
used specialized software to measure both degree and extent of stenosis. This
knowledge helps in making correct choice of prosthesis. New marks and diagrams
show reassessment of stenosed vessel in B to determine grade of
stenosis reduction.
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Fig. 4A. —Mode of deployment for bilateral stent placement. 64-year-old
male patient has superior vena cava obstruction caused by mesothelioma.
Fluoroscopic images show sequence of procedure for placement of prosthesis at
X. Maneuver is performed simultaneously by two radiologists (one on each side
of patient). Both prostheses are lengthened at same time and placed fully
extended with help of balloon catheter.
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Fig. 4B. —Mode of deployment for bilateral stent placement. 64-year-old
male patient has superior vena cava obstruction caused by mesothelioma.
Fluoroscopic images show sequence of procedure for placement of prosthesis at
X. Maneuver is performed simultaneously by two radiologists (one on each side
of patient). Both prostheses are lengthened at same time and placed fully
extended with help of balloon catheter.
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Fig. 4C. —Mode of deployment for bilateral stent placement. 64-year-old
male patient has superior vena cava obstruction caused by mesothelioma.
Fluoroscopic images show sequence of procedure for placement of prosthesis at
X. Maneuver is performed simultaneously by two radiologists (one on each side
of patient). Both prostheses are lengthened at same time and placed fully
extended with help of balloon catheter.
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Fig. 4D. —Mode of deployment for bilateral stent placement. 64-year-old
male patient has superior vena cava obstruction caused by mesothelioma.
Fluoroscopic images show sequence of procedure for placement of prosthesis at
X. Maneuver is performed simultaneously by two radiologists (one on each side
of patient). Both prostheses are lengthened at same time and placed fully
extended with help of balloon catheter.
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Fig. 5. —Only one prosthesis on one side (right side in this patient)
is needed to treat 62-year-old man with superior vena cava syndrome caused by
small cell carcinoma. Note that clearly permeable mesh of stent facilitates
left venous return. Unilateral rather than bilateral stent placement is our
preferred technique.
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Copyright © 2001 by the American Roentgen Ray Society.
