Endovascular Management of Malignant Inferior Vena Cava Syndromes

Malignant obstructions of the inferior vena cava (IVC) are a common cause of the IVC syndrome. As reports on interventional treatment of malignant inferior caval obstructions are very sparse, the purpose of this study was to retrospectively assess the outcome of endovascular treatment of symptomatic, malignant IVC syndromes.

Between 2000 and 2015, 19 patients (six women; mean age 59 years ± 14) received endovascular treatment of malignant IVC obstruction/occlusion. Patients' demographics as well as interventional and clinical outcome data were collected.

All 19 patients underwent stenting of the IVC. Technical success was 100%. Clinical success was 79% (15/19). Three patients (16%) required early re-intervention (days 1-8) due to stent compression. Three patients (16%) with initially good post-interventional results required late repeated intervention due to tumor progression, and repeated intervention could alleviate symptoms in all cases. Best results were achieved when choosing a stent diameter between 16 and 20 mm and a stent length approximately 15-20 mm longer than the lesion length. Too large stent diameters (>28 mm) can lead to stent compression, too small stent diameters (<14 mm) can lead to stent migration, and too short stent lengths can lead to a reoccurrence of symptoms with obstruction of a non-treated segment.

Endovascular treatment of malignant IVC syndromes is a safe and effective approach enabling immediate relief of inferior inflow congestions. Recurrent venous obstruction is common but can be avoided when stent diameter and stent length are adapted to the degree of IVC compression as well as expected progression of the underlying malignancy.