Endovascular Treatment of Malignant Superior Vena Cava Syndrome through Upper-Limb Access: A Comparison between Venous-Dedicated and Conventional Stents.

Abstract

PURPOSE:

To retrospectively evaluate the technical and clinical outcomes of superior vena cava (SVC) stent placement through upper-limb venous access in malignant SVC syndrome (SVCS) and compare the efficacy of different nitinol stent types.

MATERIALS AND METHODS:

Between 2006 and 2018, 156 patients (132 male; mean age, 62 y; age range, 33-81 y) underwent SVC stent placement for malignant obstructions through upper-limb venous access with 1 of 3 types of nitinol stent: 1 venous-dedicated (Sinus-XL stent) and 2 non-venous-dedicated (E-Luminexx Vascular Stent and Protégé GPS). Cases of common femoral vein access or non-nitinol stents were excluded from further analysis. The mean duration of follow-up was 8 mo.

RESULTS:

Technical success was achieved in 99.3% of cases. One patient died during the procedure as a result of cardiac tamponade. Balloon predilation was performed in 10 patients and postdilation in 126. Mean procedural time was 34.4 min (range, 18-80 min). Overall survival rates were 92.3%, 57.3%, and 26.8%, and overall primary patency rates were 94.5%, 84.8% and 79.6%, at 1, 6, and 12 mo, respectively. There were no statistically significant differences in primary patency rates between venous- and non-venous-dedicated stents or among different Stanford SVCS grading groups (P > .05).

CONCLUSIONS:

SVC stent placement through an upper-limb approach is a safe, fast, and effective technique. There is no evident benefit of venous-dedicated vs non-venous-dedicated stents in the treatment of malignant SVCS.

• Authors: Nikolas Matthaiou, Nikolaos Galanakis, Elias Kehagias, Nikolaos Kontopodis, Stavros Charalambous, Nelly Kholcheva, Konstantinos Tsetis, Dimitrios Mavroudis, Dimitrios Tsetis
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 31 Issue 12 Pg. 2066-2072 (Dec 2020) ISSN: 1535-7732 [Electronic] United States
• PMID: 33127247 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.

Chemical References

• Alloys
• nitinol

Topics

• Adult
• Aged
• Aged, 80 and over
• Alloys
• Angioplasty, Balloon (adverse effects, instrumentation)
• Catheterization, Peripheral (adverse effects)
• Female
• Humans
• Male
• Middle Aged
• Neoplasms (complications, diagnostic imaging)
• Prosthesis Design
• Registries
• Retrospective Studies
• Stents
• Superior Vena Cava Syndrome (diagnostic imaging, etiology, physiopathology, therapy)
• Time Factors
• Treatment Outcome
• Upper Extremity (blood supply)
• Vascular Patency
• Vena Cava, Superior (diagnostic imaging, physiopathology)