The use of the wallstent endovascular prosthesis in the treatment of malignant obstruction of the superior vena cava

doi:10.1016/S0009-9260(05)81105-5

Clinical Radiology

Volume 48, Issue 6, December 1993, Pages 381-385

https://doi.org/10.1016/S0009-9260(05)81105-5 Get rights and content

Seventeen patients (10 men and seven women) aged 48–76 years (mean 63.4) who were suffering from malignant superior vena caval obstruction had Wallstents implanted percutaneously to relieve the obstruction. Fifteen of the patients had previously been treated by radiotherapy or chemotherapy, with either failure to remit or later recurrence. Six patients required thrombolysis prior to stenting. All patients had rapid relief of the obstructive symptoms. This was sustained in 15 patients to date or at death. Two patients, both of whom had pre-stent lysis, developed stent thrombosis following withdrawal of anticoagulation at 4 months and 7 days respectively.

Stenting has been shown to be extremely effective at relieving superior vena caval obstruction in these patients and is usually the only method available in this condition when other treatments fail.

Whether all patients presenting with malignant superior vena caval obstruction should be stented de novo remains to be proven.

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There are more references available in the full text version of this article.

Cited by (90)

Literature Review of Percutaneous Stenting for Palliative Treatment of Malignant Superior Vena Cava Syndrome (SVCS)
2022, Academic Radiology
To assess the efficacy and safety of percutaneous stenting for the palliative treatment of malignant superior vena cava syndrome (SVCS).
Literature review of retrospective studies was performed regarding direct procedural complications (fatal and non-fatal), clinical effectiveness, and patency rates (primary and secondary) of percutaneous transluminal stenting for the palliative treatment of malignant SVCS. Pooled rates and 95% confidence intervals were calculated for fatal complications, non-fatal complications, clinical effectiveness, primary patency, and secondary patency. Pooled rates were presented overall and by stent types (Wallstent, Nitinol stents, Steel stents and Stent Graft). Odds ratios and 95% confidence intervals were calculated to compare rates by stent type.
Overall fatal complications rate was 1.46%, 95% CI [0.91 –2.23], non-fatal complications rate was 8.28%, 95% CI [6.91 –9.83], clinical effectiveness was 90.50%, 95% CI [88.86 –91.97], primary patency rate was 86.18%, 95% CI [84.06-88.12], secondary patency rate was 94.05 %, 95% CI [91.82 –95.82]. Primary patency rate of the Wallstent group was 83.38%, 95% CI [79.34 –86.90], and significantly higher for the Nitinol group 94.87%, 95% CI [87.40 –98.60], OR = 3.67, p = 0.01, and for the Stent Graft group 96.10%, 95% CI [89.00 –99.20], OR = 4.92, p = 0.01. Secondary patency rate for the Wallstent group was 93.33%, 95% CI [88.87 –96.40] and significantly lower for the Steel group 77.42%, 95% CI [58.90 –90.41], OR = 0.25, p = 0.01.
Percutaneous stenting is a safe option for palliative treatment of patients with malignant SVCS with greater than 90% of patients experiencing immediate relief of symptoms, low rates of fatal complications (1.46%) and high patency rates (86.18% primary patency and 94.05% secondary patency).
Effectiveness of endovascular prostheses as initial treatment for superior vena cava syndrome of malignant cause
2013, Medicina Clinica
El síndrome de vena cava superior (SVCS) se origina por la dificultad del retorno venoso, producida frecuentemente por un tumor invasor del mediastino. El objetivo de este estudio fue valorar la utilidad de las endoprótesis como tratamiento inicial del SVCS de causa maligna.
Desde diciembre de 1996 hasta agosto de 2010 se remitieron 120 pacientes con SVCS para tratamiento percutáneo. Setenta y seis se hallaban en seguimiento oncológico y en 44 casos se desconocía un proceso tumoral. Realizamos un estudio prospectivo no concurrente de 113 pacientes sin tratamiento radioterápico o quimioterápico previo y en los que se optó por el tratamiento intravascular como primera opción.
Se trataron 102 varones y 11 mujeres, con una media de edad de 61,18 años (extremos 45-85). Las causas del SVCS fueron: neoplasia pulmonar (100 casos), metástasis pulmonares (6), compresión por adenopatías (6) y un tumor embrionario. Se implantaron 155 prótesis. Fue suficiente un stent en 75 pacientes, 2 stents en 34 y 3 en 4. El éxito técnico fue del 98,2%. La sintomatología desapareció por completo en 97 pacientes y parcialmente en 13. Como complicaciones destacaron: migración del stent (5), epistaxis (1) y hematoma inguinal pospunción (1). Setenta y tres pacientes tuvieron una supervivencia asintomática media de 210 días (permeabilidad primaria 75%, permeabilidad secundaria 52,9%).
El empleo de endoprótesis en el SVCS de causa maligna es un procedimiento seguro y eficaz que palía la obstrucción venosa, consigue la inmediata desaparición de los síntomas, permite la estadificación del tumor subyacente, facilita la instauración del mejor tratamiento y mejora la calidad de vida.
Superior vena cava syndrome (SVCS) is caused by venous return obstruction often originated by an invading mediastinal tumour. Our objective was to evaluate the usefulness of stents as initial treatment for SVCS of malignant origin.
From December 1996 to August 2010, 120 patients with SVCS were referred for percutaneous treatment. Seventy-six were under oncological follow-up cases and in 44 cases the tumour was unknown. A non-concurrent prospective study was made of 113 patients without prior chemotherapy or radiotherapy, who opted for endovascular treatment as first option.
One hundred and two men and 11 women were treated, mean age 61.18 years old (range 45-85). SVCS causes included lung cancer (100), lung metastases (6), compression by enlarged lymph nodes (6), and an embryonic tumour. One hundred and fifty-five prostheses were implanted. One stent was enough in 75 patients, 2 stents in 34, and 3 in 4. Technical success rate was 98.2%. Symptoms disappeared completely in 97 patients and partially in 13. Complications were stent migration (5), epistaxis (1), and post-procedure groin hematoma (1). Seventy-three asymptomatic patients had a mean survival of 210 days (75% primary permeability and 52.9% secondary permeability).
The use of stents in malignant SVCS is a safe and effective procedure for venous obstruction, leading to the immediate disappearance of symptoms, allowing the underlying tumour staging, facilitating the establishment of the best treatment and improving life quality.
Superior vena caval stenting for SVC obstruction: Current status
2009, European Journal of Radiology
Citation Excerpt :
Unlike the Gianturco Z stents, the Wallstents stents are flexible and have a great efficacy in long stenoses. The main disadvantage of wall stent is its weaker expansion force in larger diameters, its unpredictable length of shortening when expanded and its tendency to migrate post-deployment from the narrowest point to the normal portion of the vein if not correctly centered on the stenosis [41,61]. These issues however, rarely become clinically significant as the length of the stents used is often 2–3 times longer than the actual length of SVCO.
Symptomatic obstruction of the superior vena cava is a debilitating and potentially life-threatening condition. Conventional surgery and radiation therapy have a historical role in the management of patients with malignant superior vena cava obstruction. Interventional radiologists can relieve these symptoms rapidly and safely in the vast majority of patients. The technical and clinical success rates are high and compare very favorably with currently available medical and surgical treatments. Although recurrent obstruction may occur, most patients can be treated by re-intervention.
Stenting for superior vena cava obstruction associated with lung cancer: Monocentric study
2009, Revue des Maladies Respiratoires
Le syndrome cave est une urgence oncologique pour laquelle la mise en place d’une prothèse cave supérieure doit être discutée.
Afin d’apprécier l’efficacité et les complications de cette méthode, nous avons étudié de manière rétrospective 41 patients porteurs de cancers bronchiques et ayant bénéficié de la mise en place de prothèses en nitinol auto expansibles durant les 5 dernières années. Le geste était associé à une anticoagulation, une corticothérapie par voie générale et un traitement étiologique.
Quarante et un patients ont bénéficié de ce traitement (30 hommes et 11 femmes) avec un âge moyen de 59 ans. Les étiologies tumorales du syndrome cave supérieur étaient : adénocarcinomes (8), cancers à petites cellules (11), carcinomes épidermoïdes (9), cancers à grandes cellules (9) ou autres types (4). Tous les patients étaient symptomatiques. Le délai moyen entre l’apparition des symptômes et la réalisation du geste était de 14 jours. Le traitement était associé à un traitement étiologique de type chimiothérapie seule pour 18 patients, radiothérapie seule pour 1 patient, radio-chimiothérapie pour 14 patients et aucun traitement pour 6 patients. Le geste consistait en la mise en place de 1 (73 %) ou 2 (27 %) prothèses, d’une longueur totale moyenne de 7,5 cm et d’un calibre moyen de 14 mm. Aucune complication n’était rapportée. Une amélioration des symptômes dans les 48 heures était obtenue chez tous les patients. La survie moyenne après mise en place de la prothèse était de 6,7 mois.
La mise en place d’une prothèse cave supérieure permet une amélioration rapide des symptômes, avec un très faible taux de complication. Sous réserve d’une technique adéquate, ce traitement doit être envisagé en première intention chez les patients présentant un cancer bronchique peu radio- ou chimiosensible compliqué d’un syndrome cave symptomatique.
M.-C. Pierre, V. Chabbert, S. Lozano, L. Bigay-Game, N. Lévêque, L. Desloques, P. Otal, H. Rousseau, A. Didier, J. Mazières
Superior vena cava obstruction is an urgent complication of lung cancer. Superior vena cava stent insertion can be considered to provide rapid relief of the symptoms.
To estimate the efficiency and the complications of this procedure, we retrospectively analyzed 41 consecutive patients treated during the last 5 years by self-expanding nitinol stent insertion for superior vena cava obstruction due to lung cancer. It was combined with anticoagulation and corticosteroids.
41 patients benefited from this treatment (30 men and 11 women) with an average age of 59 years. Etiologies of the vena cava obstruction were: small cell carcinoma (11), adenocarcinoma (8), squamous cell carcinoma (9), large cell carcinoma (9) and others (4). All patients were symptomatic. The average period between the onset of symptoms and the vascular stenting was 14 days. Specific treatment was chemotherapy (18 patients), radiotherapy (1 patient), or both (14 patients), and no specific treatment for 6 patients. The procedure consisted of the insertion of 1 (73%) or 2 (27%) stents, with an average length and caliber of 7.5 cm and 14 mm respectively. No major complication was reported in short and long-term follow up. Symptomatic improvement was observed for all the patients within 48 hours. Median survival after the stenting was of 6.7 months.
In our study, vascular stenting for malignant superior cava vena obstruction allows a rapid improvement of the symptoms with very few complications, suggesting a possible role as first line treatment for chemo or radio-resistant tumours.
Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome
2009, Thorax
Superior vena cava syndrome management has been traditionally radiation therapy, chemotherapy or chemoradiation, depending on the underlying malignancy involved and individual clinicopathological features of the case. Recent emergence of endovascular stents offer the opportunity for immediate relief of the venous stenosis. This review examines findings from the published series which used endovascular prosthesis for this syndrome with regards to efficacy and safety.
Literature search identified studies using endovascular stents as initial therapy or for recurrence of malignant superior vena cava syndrome. Effectiveness and toxicity from stent placement was assessed.
Endovascular stent placement provides immediate haemodynamic relief of venous compression either before or after definitive therapy in the majority of cancer patients. Severe bleedings, cardiopulmonary complications and stent migrations remain significant problems for patient management.
Endovascular prosthesis is an effective modality for malignant superior vena cava syndrome with acceptable morbidity. Prospective studies should be performed to determine the optimal anticoagulation regimen.
Comment on: Endovascular Stenting in Superior Vena Cava Syndrome: A Systematic Review and Meta-analysis
2023, CardioVascular and Interventional Radiology

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The use of the wallstent endovascular prosthesis in the treatment of malignant obstruction of the superior vena cava

Clinical Radiology

Role of venography in assessing patients with superior caval obstruction caused by carcinoma for bypass operations

Thorax

Bronchial carcinoma