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Eur J Cardiothorac Surg 2003;24:208-211
© 2003 Elsevier Science NL

Use of self-expanding vascular endoprostheses in superior vena cava syndrome

^a Department of Endovascular Therapy, Hospital Italiano de Buenos Aires, Gascón 450, CP 1181 Buenos Aires, Argentina
^b Department of Clinical Oncology, Hospital Italiano de Buenos Aires, Gascón 450, CP 1181 Buenos Aires, Argentina
^c Department of Thoracic Surgery and Lung Transplantation, Hospital Italiano de Buenos Aires, Gascón 450, CP 1181 Buenos Aires, Argentina

Received 2 October 2002; received in revised form 1 April 2003; accepted 2 April 2003.

^* Corresponding author. Tel./fax: +54-11-4959-0200 ext. 8869
e-mail: transplante.pulmonar{at}hospitalitaliano.org.ar

Introduction: Superior vena cava syndrome (SVCS) is associated to a malignant tumor in more than 90% of cases; being the lung cancer the most frequent (80%). SVCS has a benign cause in less than 5% of cases. Endovascular stenting has been proposed as the primary treatment of choice. We report our experience in SVC recanalization through the use of self-expanding vascular stents as treatment of life-threatening SVCS of benign and malignant etiology. Materials and methods: Between January 1994 and April 2002 44 patients with critical SVCS, were treated at the Hospital Italiano de Buenos Aires. Forty nine self-expanding endovascular metallic stents were percutaneously placed in the SVC. Thirty-one (70%) patients were male and 13 (30%) were female. The mean age was 55.6 years (range: 21–77). The etiology of SVCS was malignant in 40 cases and benign in 4. The malignant causes included lung cancer: 37 (37/44–92.5%), lymphoma: 1 (2.5%), chondrosarcoma 1 (2.5%), melanoma 1 (2.5%). The benign etiology corresponded to central catheters (n: 2) and post-radiation fibrosis (n: 2). Cavography showed complete occlusion of SVC in 12 cases (27%) and significant partial stenosis in 32 cases (73%). Thrombi associated with tumor stenosis were present in 25 (57%) patients. Results: All procedures were technically successful. No stent migration was observed. Thirty-two patients with malignant tumor ultimately died due to the progression of the disease. Mean survival time was 193 days (range: 25–578). SVCS recurrence was observed on six occasions. In four patients a new stent was placed. Symptomatic improvement was dramatically seen within 24–48 h after stent placement in 40 patients (90.9%) and 83.3% out of the cases (38/44) were symptoms-free during the rest of the disease. Three patients died in the 7 following days. Conclusion: The use of self-expanding vascular endoprostheses in the recanalization treatment of SVC in SVCS due to a malignant or benign etiology offers excellent results with rapid and prolonged remission of symptoms.

Key Words: Vascular stenting • Superior vena cava syndrome • Vascular endoprotheses • Mediastinal syndrome

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