SIR 2024
Venous Interventions
Debkumar Sarkar, DO
Associate Attending
Memorial Sloan Kettering Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
Johnathan Latzman, MD
Assistant Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Adie Friedman, MD
Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Ernesto Santos, MD
IR Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
To evaluate the safety and efficacy of unilateral balloon expandable covered stent graft placement in patients with malignant superior vena cava (SVC) syndrome.
Materials and methods:
Between January 2020 and March 2023 a total of 23 patients (16 men and 7 women; mean age, 67.1 years; range, 42-87 years) with malignant SVC syndrome underwent endovascular management with unilateral balloon expandable covered stent graft placement (Viabahn VBX stent graft). The presenting symptoms included neck and facial swelling (n = 17; 74%), bilateral upper extremity swelling (n =14; 60.8%), dyspnea (n=9; 40.9%), unilateral upper extremity swelling (n=6; 14.3%). SVC reconstruction was completed using 11 mm Viabahn VBX balloon expandable stent grafts that were unilaterally placed within the SVC or across the venous confluence to a patent brachiocephalic vein to relieve venous stenosis or obstruction and prevent tumor overgrowth, regardless of patency of contralateral brachiocephalic veins. The stent grafts were subsequently balloon expanded to 14 mm.
Results:
Balloon expandable covered stent graft placement was technically successful in all patients (n=23, 100%). There were no major complications. Two patients experienced minor access related hematomas (n=2, 8.6%). All 23(100%) patients experienced complete symptomatic relief 1-7 days (mean 3.4) after stent graft placement. Of the 23 patients, 13 patients (56.5%) underwent covered stent placement across the venous confluence, of which 9 patients (39.1%) had patent contralateral brachiocephalic veins prior to reconstruction. No patients experienced SVC obstruction or contralateral upper extremity venous thrombosis during the follow-up period. Kaplan-Meier analysis demonstrated median patient survival of 182 days. Stent occlusion occurred in 1 patient (4%). Cumulative stent patency rates at 1 and 3 months were 100% and 96% respectively with 100% secondary patency at 3 months.
Conclusion:
Unilateral balloon mounted covered stent graft placement is a very safe and effective method for treating malignant SVC syndrome.