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Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy

  • Clinical Investigation
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Abstract

Purpose

To demonstrate the effectiveness of endovascular treatment (EVT) with self-expandable bare stents for malignant superior vena cava syndrome (SVCS) and to analyze predictive factors of EVT efficacy.

Methods

Retrospective review of the 164 patients with malignant SVCS treated with EVT in our hospital from August 1992 to December 2007 and followed until February 2009. Endovascular treatment includes angioplasty before and after stent placement. We used self-expandable bare stents. We studied results of this treatment and looked for predictive factors of clinical efficacy, recurrence, and complications by statistical analysis.

Results

Endovascular treatment was clinically successful in 95% of cases, with an acceptable rate of early mortality (2.4%). Thrombosis of the superior vena cava was the only independent factor for EVT failure. The use of stents over 16 mm in diameter was a predictive factor for complications (P = 0.008). Twenty-one complications (12.8%) occurred during the follow-up period. Relapse occurred in 36 patients (21.9%), with effective restenting in 75% of cases. Recurrence of SVCS was significantly increased in cases of occlusion (P = 0.01), initial associated thrombosis (P = 0.006), or use of steel stents (P = 0.004). Long-term anticoagulant therapy did not influence the risk of recurrence or complications.

Conclusion

In malignancy, EVT with self-expandable bare stents is an effective SVCS therapy. These results prompt us to propose treatment with stents earlier in the clinical course of patients with SVCS and to avoid dilatation greater than 16 mm.

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Acknowledgments

We thank Dr. A. Foote (Grenoble Clinical Research Centre) for translation services.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Clinique universitaire de médecine interne, Pôle Pluridisciplinaire de Médecine, CHU de Grenoble, Grenoble, France

    Dorothée Fagedet

  2. Clinique universitaire de radiologie et imagerie médicale, Pôle d’Imagerie, CHU de Grenoble, Grenoble, France

    Frederic Thony, Mathieu Rodiere & Gilbert R. Ferretti

  3. Clinique universitaire de réanimation, Pôle Médecine Aiguë Communautaire, CHU de Grenoble, Grenoble, France

    Jean-François Timsit

  4. Inserm U823, University Grenoble 1 e Albert Bonniot Institute, 38 000, Grenoble, France

    Jean-François Timsit, Gilbert R. Ferretti, Aurélien Vesin & Denis Moro-Sibilot

  5. Imagerie Médicale Thoracique Cardiovasculaire, CHRU Arnaud de Villeneuve, Montpellier, France

    Valérie Monnin-Bares

  6. Clinique universitaire de pneumologie, Pôle Médecine Aiguë Communautaire, CHU de Grenoble, BP 217, 38043, Grenoble cedex 09, France

    Denis Moro-Sibilot

Authors
  1. Dorothée Fagedet
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  2. Frederic Thony
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  3. Jean-François Timsit
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  4. Mathieu Rodiere
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  5. Valérie Monnin-Bares
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  6. Gilbert R. Ferretti
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  7. Aurélien Vesin
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  8. Denis Moro-Sibilot
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Correspondence to Denis Moro-Sibilot.

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Fagedet, D., Thony, F., Timsit, JF. et al. Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy. Cardiovasc Intervent Radiol 36, 140–149 (2013). https://doi.org/10.1007/s00270-011-0310-z

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  • DOI: https://doi.org/10.1007/s00270-011-0310-z

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