Endovascular treatment of benign superior vena cava syndrome: venographic patterns and implications for treatment

We report our experience with the percutaneous treatment of superior vena cava syndromes of benign etiology.

From August 1994 to August 2003 a total of 14 superior vena cava syndromes of benign origin were treated. Previous use of a central venous catheter pending the development of a peripheral arteriovenous fistula for dialysis was believed to be the cause of the obstruction of the superior vena cava in 11 patients. In 2 other cases the cause was attributed to post-radiation mediastinal fibrosis and, in one case, to a previously implanted pacemaker. The superior vena cava syndrome was confirmed by venography. After negotiating the obstruction, a self-expanding stent was selected based on the CT and venographic data. At the end of the procedure, technical success was confirmed by venography, and haemodynamic success by pressure measurements. The follow-up allowed the assessment of the clinical success of the procedure.

Technical success was achieved in 13 patients (92.8%); in one case the obstruction could not be negotiated with the wire guide, so the patient was referred for surgery. One self-expanding stent proved sufficient to resolve the central venous obstruction and restore superior vena cava diameter in all cases but one. In one young woman, whose central obstruction was resolved with PTA, was unable to complete the procedure with deployment of a self-expanding stent owing to a supervening asthma attack that could not be treated with the commonly-used drugs. No complications related to the procedure were reported. The symptoms cleared up within 2 weeks, and haemodynamic improvements were already seen within minutes of stent deployment.

Percutaneous treatment is a valuable alternative to surgery as it is able to restore haemodynamic parameters and resolve the clinical picture, ensuring longer functionality to arteriovenous fistulae and an improved quality of life.