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Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement
S T Kee1, L Kinoshita, M K Razavi
1Department of Radiology, Stanford University Medical Center, CA 94305-5105, USA.
Insights
Catheter-directed thrombolysis and endovascular stent placement effectively treat superior vena cava (SVC) syndrome. This minimally invasive approach offers high success rates for both malignant and benign causes of SVC obstruction.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Oncology
Background:
- Superior vena cava (SVC) syndrome significantly impacts patient quality of life.
- Malignancy is a common cause of SVC syndrome, necessitating effective treatment options.
Purpose of the Study:
- To evaluate the efficacy and safety of catheter-directed thrombolysis and endovascular stent placement for SVC syndrome.
- To assess treatment outcomes in patients with both malignant and benign causes of SVC syndrome.
Main Methods:
- A cohort of 59 patients with SVC syndrome underwent venography.
- Interventions included catheter-directed thrombolysis (27 patients) and endovascular stent placement (51 patients).
- Clinical patency was defined by the absence of SVC syndrome symptoms and signs.
Main Results:
- Technical success rate was 95% (56/59 patients).
- For malignancy-related SVC syndrome, primary and secondary clinical patency rates were 79% and 93%, respectively.
- For benign SVC syndrome, primary and secondary clinical patency rates were 77% and 85%, respectively.
- Periprocedural mortality and morbidity were low at 3% and 10%.
Conclusions:
- Catheter-directed thrombolysis and endovascular stent placement represent a safe and effective treatment modality for SVC syndrome.
- These minimally invasive techniques provide significant clinical improvement for patients with SVC obstruction.
Purpose:
To evaluate use of catheter-directed thrombolysis and/or endovascular stent placement to treat superior vena cava (SVC) syndrome.
Materials And Methods:
Fifty-nine consecutive patients with SVC syndrome were studied. The cause was underlying malignancy in 43 and benign disease in 16. All patients underwent bilateral upper-extremity venography. The SVC was occluded in 31 cases and stenosed in 28. Twenty-seven patients underwent catheter-directed thrombolysis; 51 underwent endovascular stent placement. Patency was defined in terms of absence of symptoms and signs of SVC syndrome.
Results:
Technical success was achieved in 56 of 59 patients (95%). Among 42 patients with underlying malignancy (mean follow-up, 7.0 months; range, 1-34 months), primary clinical patency was achieved in 33 (79%) and secondary clinical patency was achieved in 39 (93%). Among 13 patients with benign disease (mean follow-up, 17.0 months; range, 1-27 months), primary clinical patency was achieved in 10 (77%) and secondary clinical patency was achieved in 11 (85%). Four patients were lost to follow-up. Periprocedural mortality and morbidity rates were 3% (two of 59 patients) and 10% (six of 59 patients), respectively.
Conclusion:
Catheter-directed thrombolysis and endovascular stent placement is a safe and effective treatment for SVC syndrome.