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. 1995 Nov;50(11):1151–1156. doi: 10.1136/thx.50.11.1151

Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent.

K W Stock 1, A L Jacob 1, M Proske 1, C T Bolliger 1, C Rochlitz 1, W Steinbrich 1
PMCID: PMC475086  PMID: 8553270

Abstract

BACKGROUND--Obstruction of the superior vena cava (SVC) in malignant disease can cause considerable distress to patients. Symptomatic relief can be achieved by the percutaneous implantation of a self-expanding stent (Wallstent) into the stenosis. METHODS--Fourteen patients with obstruction of the SVC were treated with one to three Wallstent endoprostheses. They suffered from advanced bronchogenic carcinoma (n = 12), thyroid carcinoma (n = 1), and breast carcinoma (n = 1). The indication for stent placement was symptomatic obstruction of the SVC and incurable disease. Stenting was performed for symptom relief, and before, during, and after courses of radiotherapy or chemotherapy as needed. RESULTS--Twelve patients experienced complete symptomatic relief within two days of stent placement. Two patients did not benefit. Three patients not given anticoagulation developed stent thrombosis between one week and eight months after initial placement, and within one day of endobronchial stent implantation with bronchial laser therapy or balloon dilatation in all three. Patency of the SVC was achieved again by a repeat procedure. CONCLUSIONS--Stent placement for obstruction of the SVC gives rapid symptomatic relief. Subsequent endobronchial stent implantation with bronchial laser therapy or balloon dilatation could be a risk for caval stent occlusion. Stent thrombosis remains a problem in patients who are not anticoagulated.

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Selected References

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  1. 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]
  2. Beck C., Berberich W., Bauknecht A., Schnabel K. Die obere Einflussstauung als Notfall in der Strahlentherapie. Strahlenther Onkol. 1990 Dec;166(12):798–802. [PubMed] [Google Scholar]
  3. 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]
  4. Chen J. C., Bongard F., Klein S. R. A contemporary perspective on superior vena cava syndrome. Am J Surg. 1990 Aug;160(2):207–211. doi: 10.1016/s0002-9610(05)80308-3. [DOI] [PubMed] [Google Scholar]
  5. Dyet J. F., Nicholson A. A., Cook A. M. The use of the Wallstent endovascular prosthesis in the treatment of malignant obstruction of the superior vena cava. Clin Radiol. 1993 Dec;48(6):381–385. doi: 10.1016/s0009-9260(05)81105-5. [DOI] [PubMed] [Google Scholar]
  6. Edwards R. D., Cassidy J., Taylor A. Case report: superior vena cava obstruction complicated by central venous thrombosis--treatment with thrombolysis and Gianturco-Z stents. Clin Radiol. 1992 Apr;45(4):278–280. doi: 10.1016/s0009-9260(05)80016-9. [DOI] [PubMed] [Google Scholar]
  7. Edwards R. D., Jackson J. E. Case report: superior vena caval obstruction treated by thrombolysis, mechanical thrombectomy and metallic stents. Clin Radiol. 1993 Sep;48(3):215–217. doi: 10.1016/s0009-9260(05)80288-0. [DOI] [PubMed] [Google Scholar]
  8. Elson J. D., Becker G. J., Wholey M. H., Ehrman K. O. Vena caval and central venous stenoses: management with Palmaz balloon-expandable intraluminal stents. J Vasc Interv Radiol. 1991 May;2(2):215–223. doi: 10.1016/s1051-0443(91)72285-9. [DOI] [PubMed] [Google Scholar]
  9. 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]
  10. Kishi K., Sonomura T., Mitsuzane K., Nishida N., Yang R. J., Sato M., Yamada R., Shirai S., Kobayashi H. Self-expandable metallic stent therapy for superior vena cava syndrome: clinical observations. Radiology. 1993 Nov;189(2):531–535. doi: 10.1148/radiology.189.2.8210386. [DOI] [PubMed] [Google Scholar]
  11. Oudkerk M., Heystraten F. M., Stoter G. Stenting in malignant vena caval obstruction. Cancer. 1993 Jan 1;71(1):142–146. doi: 10.1002/1097-0142(19930101)71:1<142::aid-cncr2820710123>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. 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]
  14. 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]
  15. Rösch J., Uchida B. T., Hall L. D., Antonovic R., Petersen B. D., Ivancev K., Barton R. E., Keller F. S. Gianturco-Rösch expandable Z-stents in the treatment of superior vena cava syndrome. Cardiovasc Intervent Radiol. 1992 Sep-Oct;15(5):319–327. doi: 10.1007/BF02733957. [DOI] [PubMed] [Google Scholar]
  16. Therasse E., Soulez G., Cartier P., Passerini L., Roy P., Bruneau L., Gaboury L. Infection with fatal outcome after endovascular metallic stent placement. Radiology. 1994 Aug;192(2):363–365. doi: 10.1148/radiology.192.2.8029398. [DOI] [PubMed] [Google Scholar]
  17. Therasse E., Soulez G., Cartier P., Passerini L., Roy P., Bruneau L., Gaboury L. Infection with fatal outcome after endovascular metallic stent placement. Radiology. 1994 Aug;192(2):363–365. doi: 10.1148/radiology.192.2.8029398. [DOI] [PubMed] [Google Scholar]
  18. Vanhoenacker P., Crolla D., De Muynck P. Venous stenting with a self-expanding prosthesis in superior vena cava syndrome. Rofo. 1994 Feb;160(2):178–180. doi: 10.1055/s-2008-1032400. [DOI] [PubMed] [Google Scholar]
  19. Watkinson A. F., Hansell D. M. Expandable Wallstent for the treatment of obstruction of the superior vena cava. Thorax. 1993 Sep;48(9):915–920. doi: 10.1136/thx.48.9.915. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Zollikofer C. L., Antonucci F., Stuckmann G., Mattias P., Brühlmann W. F., Salomonowitz E. K. Use of the Wallstent in the venous system including hemodialysis-related stenoses. Cardiovasc Intervent Radiol. 1992 Sep-Oct;15(5):334–341. doi: 10.1007/BF02733959. [DOI] [PubMed] [Google Scholar]

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