Original Research

Endovascular therapy of acute tumour-related obstruction of the superior vena cava using a self-expanding Nitinol stent

Peter Kamusella, Christian Wissgott, Reimer Andresen
South African Journal of Radiology | Vol 17, No 4 | a4 | DOI: https://doi.org/10.4102/sajr.v17i4.4 | © 2013 Peter Kamusella, Christian Wissgott, Reimer Andresen | This work is licensed under CC Attribution 4.0
Submitted: 21 February 2013 | Published: 08 November 2013

About the author(s)

Peter Kamusella, Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum – Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
Christian Wissgott, Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum – Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
Reimer Andresen, Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum – Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany


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Abstract

Objective: To evaluate, in a retrospective study, the clinical efficacy and safety of the self-expanding Nitinol stent in the superior vena cava to alleviate upper venous congestion.

Method: In 22 patients (15 men, 7 women), a tumour-related compression of the superior vena cava was diagnosed by spiral CT after intravenous application of contrast medium. Clinically, acute superior vena cava syndrome was found in all patients. Histologically, a bronchial carcinoma was present in 14/22, a lymphoma in 6/22, and mediastinal lymphnode metastases (1 breast carcinoma, 1 malignant melanoma) in 2/22. After a transfemoral approach, cavography was initially performed. The degree of stenosis was classified according to the Stanford classification. In accordance with the degree of stenosis, a self-expanding Nitinol stent was placed.

Results: Endovascular stent implantation was conducted without complications in all patients. A marked improvement in acute symptoms was observed clinically within 24 hours in all patients. In the follow-up period of up to 2 years, there were no cases of stent migration. In 7/22 patients, the CT follow-ups revealed tumour progression (3/7 after 3 months, 2/7 after 6 months, and 2/7 after 12 months) with evidence of residual stenosis caused by tumour growth through the stent mesh. During the follow-up period, 15/22 patients died (mean survival 6.4 months).

Conclusion: Self-expanding Nitinol stents provide endovascular therapy for superior vena cava syndrome, having a high radial expansive force and the facility to be placed precisely, and alleviating acute, life-threatening symptoms in the palliative situation.


Keywords

Computed tomography; Cavography; Angioplasty

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