Korean Journal of Radiology

  • 제15권1호
  • /
  • Pages.87-94
  • /
  • 2014
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Covered Stent Placement for the Treatment of Malignant Superior Vena Cava Syndrome: Is Unilateral Covered Stenting Safe and Effective?

  • Cho, Younghoon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Gwon, Dong Il (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ko, Gi-Young (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ko, Heung Kyu (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Jin Hyoung (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shin, Ji Hoon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Yoon, Hyun-Ki (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Sung, Kyu-Bo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2013.07.16
  • 심사 : 2013.10.10
  • 발행 : 2014.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To evaluate the safety and efficacy of unilateral covered stent placement in patients with malignant superior vena cava (SVC) syndrome. Materials and Methods: Between October 2008 and November 2012, expanded polytetrafluoroethylene-covered stent placement for malignant SVC syndrome was performed in 40 consecutive patients (35 men and five women; mean age, 61.4 years; range, 35-81 years). All covered stents were unilaterally placed within the SVC or across the venous confluence when needed to relieve venous obstruction and prevent tumor overgrowth, regardless of patency of contralateral brachiocephalic veins. Results: Stent placement was technically successful in all patients. There were no major complications. Of the 37 patients symptomatic prior to stent placement, 34 (92%) experienced complete symptomatic relief 1-8 days after stent placement. Of the 29 patients who underwent covered stent placement across the venous confluence, nine patients had patent contralateral brachiocephalic veins prior to stent placement. However, no sign of SVC obstruction or contralateral upper extremity venous thrombosis was observed during the follow-up period. Kaplan-Meier analysis revealed median patient survival of 163 days. Stent occlusion occurred in four (10%) of 40 patents. Cumulative stent patency rates at 1, 3, 6, and 12 months were 95%, 92%, 86%, and 86%, respectively. Conclusion: Unilateral covered stent placement appears to be a safe and effective method for treating malignant SVC syndrome, despite the location of SVC occlusion.

키워드

참고문헌

  1. Reechaipichitkul W, Thongpaen S. Etiology and outcome of superior vena cava (SVC) obstruction in adults. Southeast Asian J Trop Med Public Health 2004;35:453-457
  2. Rowell NP, Gleeson FV. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. Clin Oncol (R Coll Radiol) 2002;14:338-351 https://doi.org/10.1053/clon.2002.0095
  3. Picquet J, Blin V, Dussaussoy C, Jousset Y, Papon X, Enon B. Surgical reconstruction of the superior vena cava system: indications and results. Surgery 2009;145:93-99 https://doi.org/10.1016/j.surg.2008.08.003
  4. Dyet JF, Nicholson AA, Cook AM. The use of the Wallstent endovascular prosthesis in the treatment of malignant obstruction of the superior vena cava. Clin Radiol 1993;48:381-385 https://doi.org/10.1016/S0009-9260(05)81105-5
  5. Urban T, Lebeau B, Chastang C, Leclerc P, Botto MJ, Sauvaget J. Superior vena cava syndrome in small-cell lung cancer. Arch Intern Med 1993;153:384-387 https://doi.org/10.1001/archinte.1993.00410030088012
  6. Smayra T, Otal P, Chabbert V, Chemla P, Romero M, Joffre F, et al. Long-term results of endovascular stent placement in the superior caval venous system. Cardiovasc Intervent Radiol 2001;24:388-394 https://doi.org/10.1007/s00270-001-0055-1
  7. Azizzadeh A, Pham MT, Estrera AL, Coogan SM, Safi HJ. Endovascular repair of an iatrogenic superior vena caval injury: a case report. J Vasc Surg 2007;46:569-571 https://doi.org/10.1016/j.jvs.2007.04.014
  8. Chin DH, Petersen BD, Timmermans H, Rosch J. Stent-graft in the management of superior vena cava syndrome. Cardiovasc Intervent Radiol 1996;19:302-304 https://doi.org/10.1007/BF02577657
  9. Gill K, Ettles DF, Nicholson AA. Recurrent superior vena caval obstruction due to invasion by malignant thymoma: treatment using a stent-graft. Br J Radiol 2000;73:1015-1017 https://doi.org/10.1259/bjr.73.873.11064660
  10. Mansour M, Altenburg A, Haage P. Successful emergency stent implantation for superior vena cava perforation during malignant stenosis venoplasty. Cardiovasc Intervent Radiol 2009;32:1312-1316 https://doi.org/10.1007/s00270-009-9587-6
  11. Gwon DI, Paik SH. Successful treatment of malignant superior vena cava syndrome using a stent-graft. Korean J Radiol 2012;13:227-231 https://doi.org/10.3348/kjr.2012.13.2.227
  12. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14:S199-S202 https://doi.org/10.1097/01.RVI.0000094584.83406.3e
  13. Bierdrager E, Lampmann LE, Lohle PN, Schoemaker CM, Schijen JH, Palmen FM, et al. Endovascular stenting in neoplastic superior vena cava syndrome prior to chemotherapy or radiotherapy. Neth J Med 2005;63:20-23
  14. Gross CM, Kramer J, Waigand J, Uhlich F, Schroder G, Thalhammer C, et al. Stent implantation in patients with superior vena cava syndrome. AJR Am J Roentgenol 1997;169:429-432 https://doi.org/10.2214/ajr.169.2.9242747
  15. Nagata T, Makutani S, Uchida H, Kichikawa K, Maeda M, Yoshioka T, et al. Follow-up results of 71 patients undergoing metallic stent placement for the treatment of a malignant obstruction of the superior vena cava. Cardiovasc Intervent Radiol 2007;30:959-967 https://doi.org/10.1007/s00270-007-9088-4
  16. Lanciego C, Pangua C, Chacon JI, Velasco J, Boy RC, Viana A, et al. Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome. AJR Am J Roentgenol 2009;193:549-558 https://doi.org/10.2214/AJR.08.1904
  17. Nicholson AA, Ettles DF, Arnold A, Greenstone M, Dyet JF. Treatment of malignant superior vena cava obstruction: metal stents or radiation therapy. J Vasc Interv Radiol 1997;8:781-788 https://doi.org/10.1016/S1051-0443(97)70660-2
  18. Watkinson AF, Yeow TN, Fraser C. Endovascular stenting to treat obstruction of the superior vena cava. BMJ 2008;336:1434-1437 https://doi.org/10.1136/bmj.39562.512789.80
  19. Nguyen NP, Borok TL, Welsh J, Vinh-Hung V. Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome. Thorax 2009;64:174-178 https://doi.org/10.1136/thx.2007.086017
  20. Uberoi R. Quality assurance guidelines for superior vena cava stenting in malignant disease. Cardiovasc Intervent Radiol 2006;29:319-322 https://doi.org/10.1007/s00270-005-0284-9
  21. Ganeshan A, Hon LQ, Warakaulle DR, Morgan R, Uberoi R. Superior vena caval stenting for SVC obstruction: current status. Eur J Radiol 2009;71:343-349 https://doi.org/10.1016/j.ejrad.2008.04.014
  22. Kee ST, Kinoshita L, Razavi MK, Nyman UR, Semba CP, Dake MD. Superior vena cava syndrome: treatment with catheterdirected thrombolysis and endovascular stent placement. Radiology 1998;206:187-193 https://doi.org/10.1148/radiology.206.1.9423671
  23. Fagedet D, Thony F, Timsit JF, Rodiere M, Monnin-Bares V, Ferretti GR, et al. Endovascular treatment of malignant superior vena cava syndrome: results and predictive factors of clinical efficacy. Cardiovasc Intervent Radiol 2013;36:140-149 https://doi.org/10.1007/s00270-011-0310-z
  24. Dinkel HP, Mettke B, Schmid F, Baumgartner I, Triller J, Do DD. Endovascular treatment of malignant superior vena cava syndrome: is bilateral wallstent placement superior to unilateral placement? J Endovasc Ther 2003;10:788-797 https://doi.org/10.1583/1545-1550(2003)010<0788:ETOMSV>2.0.CO;2
  25. Urruticoechea A, Mesia R, Dominguez J, Falo C, Escalante E, Montes A, et al. Treatment of malignant superior vena cava syndrome by endovascular stent insertion. Experience on 52 patients with lung cancer. Lung Cancer 2004;43:209-214 https://doi.org/10.1016/S0169-5002(03)00361-1
  26. Wan JF, Bezjak A. Superior vena cava syndrome. Hematol Oncol Clin North Am 2010;24:501-513 https://doi.org/10.1016/j.hoc.2010.03.003
  27. Furui S, Sawada S, Kuramoto K, Inoue Y, Irie T, Makita K, et al. Gianturco stent placement in malignant caval obstruction: analysis of factors for predicting the outcome. Radiology 1995;195:147-152 https://doi.org/10.1148/radiology.195.1.7892457
  28. Gwon DI, Ko GY, Kim JH, Shin JH, Yoon HK, Sung KB. Malignant superior vena cava syndrome: a comparative cohort study of treatment with covered stents versus uncovered stents. Radiology 2013;266:979-987 https://doi.org/10.1148/radiol.12120517

피인용 문헌

  1. Endovascular Treatment of Superior Vena Cava Syndrome via Balloon-in-Balloon Catheter Technique with a Palmaz Stent vol.43, pp.6, 2014, https://doi.org/10.14503/thij-15-5479
  2. Diagnostik und endovaskuläre Therapie venöser Erkrankungen vol.57, pp.9, 2014, https://doi.org/10.1007/s00117-017-0284-1
  3. The Role of Interventional Oncology in the Management of Lung Cancer vol.40, pp.2, 2014, https://doi.org/10.1007/s00270-016-1495-y
  4. Gianturco Z-Stent Fixation of a Modified Iliac Limb Stent-Graft Endoprosthesis for the Treatment of Malignant Superior Vena Cava Syndrome vol.45, pp.None, 2017, https://doi.org/10.1016/j.avsg.2017.06.037
  5. Treatment of venous stenosis in oncologic patients vol.14, pp.28, 2014, https://doi.org/10.2217/fon-2017-0737
  6. Superior vena cava syndrome vol.49, pp.6, 2020, https://doi.org/10.1024/0301-1526/a000908
  7. Covered versus uncovered stent insertion for malignant superior vena cava obstruction vol.29, pp.6, 2014, https://doi.org/10.1080/13645706.2019.1653925