Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Is Bilateral Wallstent Placement Superior to Unilateral Placement?

Abstract

Purpose:

To report our experience with unilateral versus bilateral stent placement in the treatment of malignant superior vena cava syndrome (SVCS).

Methods:

The records and films of 84 consecutive patients (69 men; mean age 64±10 years, range 39–79) referred for stent placement in malignant SVCS were reviewed for venous compromise, technical and clinical success, complications, and reocclusions. Wallstents were placed covering the SVC and both (bilateral technique) brachiocephalic veins (BCV) preferentially; unilateral stenting of only one BCV in addition to the SVC was performed based on operator preference or inability to access both sides. Technical success was defined as the ability to stent the SVC and at least one BCV; clinical success was the elimination of SVCS symptoms.

Results:

Technical success was achieved in 83 (99%) patients, using the unilateral technique in 22 and bilateral stenting in 61 patients. The groups did not differ with regard to age, sex, underlying diseases, or location and extent of venous compromise. Immediate clinical success was achieved in 20 (91%) of 22 patients in the unilateral group and 55 (90%) of 61 patients in the bilateral group. Two patients suffered late occlusion in the unilateral group, while in the bilateral group, 8 patients had early occlusion and 9 had late occlusion. Thus, the total occlusion rate was significantly (p<0.05) lower in the unilateral group. There was 1 other complication (pericardial tamponade) in the bilateral group, for a 28% total complication rate, which was significantly higher (p = 0.039) than the 9% in the unilateral group. The 1, 3, 6, and 12-month primary stent patency rates were 90%, 81%, 76%, and 69%, respectively. Patency tended to last longer in the unilateral group, but the difference was not significant (p = 0.11).

Conclusions:

Although bilateral Wallstent placement achieved equal technical and clinical success, it tended to confer shorter-lived patency and caused more complications.

Keywords

superior vena cava syndrome brachiocephalic vein Wallstent outcome analysis complications reocclusion

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References

Nicholson

Ettles

Arnold

. Treatment of malignant superior vena cava obstruction: Metal stents or radiation therapy. J Vasc Interv Radiol. 1997; 8: 781–788.

Zollikofer

Antonucci

Stuckmann

. Use of the Wallstent in the venous system including hemodialysis-related stenoses. Cardiovasc Intervent Radiol. 1992; 15: 334–341.

Hennequin

Fade

Fays

. Superior vena cava stent placement: Results with the Wallstent endoprosthesis. Radiology. 1995; 196: 353–361.

Irving

Dondelinger

Reidy

. Gianturco self-expanding stents: Clinical experience in the vena cava and large veins. Cardiovasc Intervent Radiol. 1992; 15: 328–333.

Furui

Sawada

Kuramoto

. Gianturco stent placement in malignant caval obstruction: Analysis of factors for predicting the outcome. Radiology. 1995; 195: 147–152.

Kee

Kinoshita

Razavi

. Superior vena cava syndrome: Treatment with catheter-directed thrombolysis and endovascular stent placement. Radiology. 1998; 206: 187–193.

Qanadli

El Hajjam

Mignon

. Subacute and chronic benign superior vena cava obstructions: Endovascular treatment with self-expanding metallic stents. AJR Am J Roentgenol. 1999; 173: 159–164.

Kalman

Lindsay

Clarke

. Management of upper extremity central venous obstruction using interventional radiology. Ann Vasc Surg. 1998; 12: 202–206.

Kishi

Sonomura

Mitsuzane

. Self-expandable metallic stent therapy for superior vena cava syndrome: Clinical observations. Radiology. 1993; 189: 531–535.

10.

Borsa

Daly

Fontaine

. Treatment of inferior vena cava anastomotic stenoses with the Wallstent endoprosthesis after orthotopic liver transplantation. J Vasc Interv Radiol. 1999; 10: 17–22.

11.

Larsson

Lepore

. Technical options in reconstruction of large mediastinal veins. Surgery. 1992; 111: 311–317.

12.

Doty

Flores

Doty

. Superior vena cava obstruction: Bypass using spiral vein graft. Ann Thorac Surg. 1999; 67: 1111–1116.

13.

Dyet

Nicholson

Cook

. The use of the Wallstent endovascular prosthesis in the treatment of malignant obstruction of the superior vena cava. Clin Radiol. 1993; 48: 381–385.

14.

Lanciego

Chacon

Julian

. Stenting as first option for endovascular treatment of malignant superior vena cava syndrome. AJR Am J Roentgenol. 2001; 177: 585–593.

15.

Oudkerk

Kuijpers

Schmitz

. Self-expanding metal stents for palliative treatment of superior vena caval syndrome. Cardiovasc Intervent Radiol. 1996; 19: 146–151.

16.

Tanigawa

Sawada

Mishima

. Clinical outcome of stenting in superior vena cava syndrome associated with malignant tumors. Comparison with conventional treatment. Acta Radiol. 1998; 39: 669–674.

17.

Marcy

Magne

Bentolila

. Superior vena cava obstruction: Is stenting necessary? Support Care Cancer. 2001; 9: 103–107.

18.

Martin

Baumgartner

Kolb

. Fatal pericardial tamponade after Wallstent implantation for malignant superior vena cava syndrome. J Endovasc Ther. 2002; 9: 680–684.

19.

Dinkel

Triller

. Primary and long-term success of percutaneous biliary metallic endoprostheses (Wallstents) in malignant obstructive jaundice [in German]. Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr. 2001; 173: 1072–1078.

20.

Miller

McBride

Little

. Malignant superior vena cava obstruction: Stent placement via the subclavian route. Cardiovasc Intervent Radiol. 2000; 23: 155–158.

21.

Slonim

Dake

Razavi

. Management of misplaced or migrated endovascular stents. J Vasc Interv Radiol. 1999; 10: 851–859.

22.

Mathias

Jäger

Willaschek

. Interventional radiology in central venous obstructions. Dilatation—stent implantation—thrombolysis [in German]. Radiologe. 1998; 38: 606–613.

23.

Thony

Moro

Witmeyer

. Endovascular treatment of superior vena cava obstruction in patients with malignancies. Eur Radiol. 1999; 9: 965–971.