Vena caval and central venous stenoses: management with Palmaz balloon-expandable intraluminal stents

Palmaz balloon-expandable intraluminal stents (BEISs) were used to treat vena caval and adjacent central venous obstructions that failed to respond to conventional balloon angioplasty. An initial series included seven patients: five had superior vena cava (SVC) syndrome due to a malignant neoplasm and/or radiation therapy, one had dialysis access-related stenosis of the subclavian vein, and one had inferior vena cava (IVC) and bilateral common iliac vein obstruction due to abdominopelvic radiation therapy for Hodgkin disease. Treatment produced clinical benefit in all seven patients. Patency was achieved with stents placed across stenoses of the SVC, IVC, and brachiocephalic and subclavian veins. One stent placed in a left common iliac vein was oval and was shown to be occluded on a follow-up computed tomographic scan, suggesting that compression between the right common iliac artery and the spine was responsible. Although caution is recommended in placement at possible compression sites, BEISs can be used to treat obstructions of the vena cava and major central veins.