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CardioVascular and Interventional Radiology

, Volume 36, Issue 1, pp 140–149 | Cite as

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

  • Dorothée Fagedet
  • Frederic Thony
  • Jean-François Timsit
  • Mathieu Rodiere
  • Valérie Monnin-Bares
  • Gilbert R. Ferretti
  • Aurélien Vesin
  • Denis Moro-SibilotEmail author
Clinical Investigation

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.

Keywords

Endovascular procedure Stents Superior vena cava obstruction Thoracic neoplasms 

Notes

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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Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  • Dorothée Fagedet
    • 1
  • Frederic Thony
    • 2
  • Jean-François Timsit
    • 3
    • 4
  • Mathieu Rodiere
    • 2
  • Valérie Monnin-Bares
    • 5
  • Gilbert R. Ferretti
    • 2
    • 4
  • Aurélien Vesin
    • 4
  • Denis Moro-Sibilot
    • 4
    • 6
    Email author
  1. 1.Clinique universitaire de médecine interne, Pôle Pluridisciplinaire de MédecineCHU de GrenobleGrenobleFrance
  2. 2.Clinique universitaire de radiologie et imagerie médicale, Pôle d’ImagerieCHU de GrenobleGrenobleFrance
  3. 3.Clinique universitaire de réanimation, Pôle Médecine Aiguë CommunautaireCHU de GrenobleGrenobleFrance
  4. 4.Inserm U823University Grenoble 1 e Albert Bonniot InstituteGrenobleFrance
  5. 5.Imagerie Médicale Thoracique CardiovasculaireCHRU Arnaud de VilleneuveMontpellierFrance
  6. 6.Clinique universitaire de pneumologie, Pôle Médecine Aiguë CommunautaireCHU de GrenobleGrenoble cedex 09France

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