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[Interventional radiology in central venous obstructions. Dilatation--stent implantation--thrombolysis]
K Mathias1, H Jäger, J Willaschek
1Radiologische Klinik, Städtische Kliniken, Dortmund.
Insights
Recanalization procedures effectively treat superior and inferior caval obstruction, relieving symptoms with minimal complications. Wallstents demonstrated superiority over Gianturco-Z stents in this patient cohort.
Area of Science:
- Interventional Radiology
- Vascular Surgery
- Oncology
Background:
- Superior and inferior caval obstruction represent critical medical emergencies.
- Timely intervention is crucial for managing venous congestion in these vital systems.
Purpose of the Study:
- To analyze the efficacy and utility of various recanalization procedures for superior and inferior caval obstruction.
- To compare the outcomes of different stent types and adjunctive therapies.
Main Methods:
- Retrospective analysis of 176 patients with superior and 28 with inferior caval obstruction.
- Treatment involved balloon venoplasty followed by stent implantation (Gianturco-Z or Wallstents).
- Local thrombolysis with urokinase was utilized in 27 cases.
Main Results:
- High success rate for interventional procedures (198/204 patients).
- Symptom relief was observed in most patients during or shortly after recanalization.
- No major complications were reported.
Conclusions:
- Balloon angioplasty with stent placement and local thrombolysis are effective treatments for caval obstruction.
- Self-expanding Wallstents are preferred over Gianturco-Z stents.
- Oncologists should be educated on these interventional techniques.
Purpose:
Venous congestion of the superior or inferior caval system has to be considered as a medical emergency. The results of various recanalization procedures and their utility are analyzed.
Patients And Methods:
176 patients with superior and 28 with inferior caval obstruction were treated with Gianturco-Z (n = 39) and Wall Stents (n = 207) respectively. Balloon venoplasty was performed prior to stent implanation. In 27 cases, local thrombolysis with urokinase was employed.
Results:
Interventional procedures were successful in 198 and without success in 6 patients. In most patients, symptoms were relieved during or early after recanalization. No major complications were found.
Discussion:
Balloon angioplasty with stent placement and local thrombolysis are successful in the treatment of superior and inferior caval obstruction. Self-expanding Wallstents are superior to Gianturco-Z-stents. Oncologists should be made familiar with this type of treatment.