Abstract
BACKGROUND--Palliative treatments for obstruction of the superior vena cava all have disadvantages. The use of a fine braided wire self expanding stent (Wallstent, Schneider (Europe) AG) in patients with malignant and benign causes of superior vena cava obstruction is reported. METHODS--Five patients with obstruction of the superior vena cava were treated with balloon angioplasty of the stricture and the percutaneous insertion of an expandable Wallstent endoprosthesis across the site of the stricture. Four patients had advanced mediastinal malignancy previously treated by radiotherapy and one patient had fibrosing mediastinitis. RESULTS--All patients experienced rapid symptomatic relief and, in three cases, complete palliation was achieved during survival times of seven weeks, nine weeks, and 24 weeks, respectively. Two surviving patients (with a recurrent thymoma and fibrosing mediastinitis) were free of symptoms when followed up at eight and nine months respectively. CONCLUSIONS--Initial experience with the Wallstent endoprosthesis suggests that it is a valuable treatment alternative once conventional therapy has failed and gives rapid relief of symptoms to patients with obstruction of the superior vena cava.
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- Adam A., Chetty N., Roddie M., Yeung E., Benjamin I. S. Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR Am J Roentgenol. 1991 Feb;156(2):321–325. doi: 10.2214/ajr.156.2.1702574. [DOI] [PubMed] [Google Scholar]
- Ali M. K., Ewer M. S., Balakrishnan P. V., Ochoa D. A., Morice R. C., Raizner A. E., Lawrie G. M. Balloon angioplasty for superior vena cava obstruction. Ann Intern Med. 1987 Dec;107(6):856–857. doi: 10.7326/0003-4819-107-6-856. [DOI] [PubMed] [Google Scholar]
- Antonucci F., Salomonowitz E., Stuckmann G., Stiefel M., Largiadèr J., Zollikofer C. L. Placement of venous stents: clinical experience with a self-expanding prosthesis. Radiology. 1992 May;183(2):493–497. doi: 10.1148/radiology.183.2.1561356. [DOI] [PubMed] [Google Scholar]
- Breckwoldt W. L., Belkin M., Gould K., Allen M., Connolly R. J., Termin P. Modification of the thrombogenicity of a self-expanding vascular stent. J Invest Surg. 1991;4(3):269–278. doi: 10.3109/08941939109141159. [DOI] [PubMed] [Google Scholar]
- Charnsangavej C., Carrasco C. H., Wallace S., Wright K. C., Ogawa K., Richli W., Gianturco C. Stenosis of the vena cava: preliminary assessment of treatment with expandable metallic stents. Radiology. 1986 Nov;161(2):295–298. doi: 10.1148/radiology.161.2.3763891. [DOI] [PubMed] [Google Scholar]
- Goodman R. Superior vena cava syndrome. Clinical management. JAMA. 1975 Jan 6;231(1):58–61. doi: 10.1001/jama.231.1.58. [DOI] [PubMed] [Google Scholar]
- Hoak B. A., Chapman J., Tiley E., Boland J. P. Quick and easy management of superior vena caval syndrome. Am Surg. 1986 Nov;52(11):622–623. [PubMed] [Google Scholar]
- Irving J. D., Dondelinger R. F., Reidy J. F., Schild H., Dick R., Adam A., Maynar M., Zollikofer C. L. Gianturco self-expanding stents: clinical experience in the vena cava and large veins. Cardiovasc Intervent Radiol. 1992 Sep-Oct;15(5):328–333. doi: 10.1007/BF02733958. [DOI] [PubMed] [Google Scholar]
- Perez C. A., Presant C. A., Van Amburg A. L., 3rd Management of superior vena cava syndrome. Semin Oncol. 1978 Jun;5(2):123–134. [PubMed] [Google Scholar]
- Putnam J. S., Uchida B. T., Antonovic R., Rösch J. Superior vena cava syndrome associated with massive thrombosis: treatment with expandable wire stents. Radiology. 1988 Jun;167(3):727–728. doi: 10.1148/radiology.167.3.3363130. [DOI] [PubMed] [Google Scholar]
- Quinn S. F., Schuman E. S., Hall L., Gross G. F., Uchida B. T., Standage B. A., Rosch J., Ivancev K. Venous stenoses in patients who undergo hemodialysis: treatment with self-expandable endovascular stents. Radiology. 1992 May;183(2):499–504. doi: 10.1148/radiology.183.2.1561357. [DOI] [PubMed] [Google Scholar]
- Rösch J., Bedell J. E., Putnam J., Antonovic R., Uchida B. Gianturco expandable wire stents in the treatment of superior vena cava syndrome recurring after maximum-tolerance radiation. Cancer. 1987 Sep 15;60(6):1243–1246. doi: 10.1002/1097-0142(19870915)60:6<1243::aid-cncr2820600614>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
- Sherry C. S., Diamond N. G., Meyers T. P., Martin R. L. Successful treatment of superior vena cava syndrome by venous angioplasty. AJR Am J Roentgenol. 1986 Oct;147(4):834–835. doi: 10.2214/ajr.147.4.834. [DOI] [PubMed] [Google Scholar]
- Sigwart U., Puel J., Mirkovitch V., Joffre F., Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med. 1987 Mar 19;316(12):701–706. doi: 10.1056/NEJM198703193161201. [DOI] [PubMed] [Google Scholar]
- Solomon N., Wholey M. H., Jarmolowski C. R. Intravascular stents in the management of superior vena cava syndrome. Cathet Cardiovasc Diagn. 1991 Aug;23(4):245–252. doi: 10.1002/ccd.1810230404. [DOI] [PubMed] [Google Scholar]
- Stanford W., Doty D. B. The role of venography and surgery in the management of patients with superior vena cava obstruction. Ann Thorac Surg. 1986 Feb;41(2):158–163. doi: 10.1016/s0003-4975(10)62659-8. [DOI] [PubMed] [Google Scholar]
- Williams G., Jager R., McLoughlin J., el Din A., Machan L., Gill K., Asopa R., Adam A. Use of stents for treating obstruction of urinary outflow in patients unfit for surgery. BMJ. 1989 May 27;298(6685):1429–1429. doi: 10.1136/bmj.298.6685.1429. [DOI] [PMC free article] [PubMed] [Google Scholar]