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American Journal of Roentgenology, Vol 173, 159-164, Copyright © 1999 by American Roentgen Ray Society

ARTICLES

Subacute and chronic benign superior vena cava obstructions: endovascular treatment with self-expanding metallic stents

SD Qanadli, M El Hajjam, F Mignon, E de Kerviler, P Rocha, O Barre, S Chagnon and P Lacombe
Department of Radiology, Ambroise Pare Hospital, University Rene Descartes-Paris V, Boulogne, France.

OBJECTIVE: Our purpose is to report our clinical experience with patients who underwent endovascular treatment with Wallstents for subacute or chronic benign obstruction of the superior vena cava (SVC). SUBJECTS AND METHODS: Twelve patients who were an average of 54 +/- 12 years old were referred for treatment of severe SVC syndrome related to implanted central venous catheters (n = 8), postradiation fibrosis (n = 2), a permanent pacemaker (n = 1), or a benign tumor (n = 1). Symptoms were present for an average of 16 weeks (range, 4-48 weeks) before treatment. Diagnosis of SVC obstruction was confirmed with helical CT and pretherapeutic phlebography. Four patients had Stanford's type II stenosis; two, type III; and six, type IV. The mean clinical and radiologic follow-up intervals were 11 months (range, 1-36 months) and 7 months (range, 1 week to 32 months), respectively. RESULTS: Recanalization was successful in all patients. Fifteen stents were implanted in the 12 patients. Stents were placed after percutaneous balloon angioplasty in nine patients, and primary stent placement was attempted in three patients. We immediately achieved a satisfactory SVC diameter in all patients, whose symptoms were relieved completely within 1 week of stent placement. No technical or clinical complications occurred. SVC syndrome recurred in one patient 2 months after stent placement and was treated by placing a second stent. CONCLUSION: Endovascular treatment with stent placement should be considered relevant and safe for refractory benign SVC syndrome. However, a larger series and a longer follow-up period are needed to define the role of stent placement for this syndrome.
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C. Lanciego, J. L. Chacon, A. Julian, J. Andrade, L. Lopez, B. Martinez, M. Cruz, and L. Garcia-Garcia
Stenting as First Option for Endovascular Treatment of Malignant Superior Vena Cava Syndrome
Am. J. Roentgenol., September 1, 2001; 177(3): 585 - 593.
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