115 - Efficacy of Unilateral Balloon Expandable Covered Stent Graft Placement Covering the Contralateral Brachiocephalic Vein for Malignant Superior Vena Cava Syndrome

Purpose: Malignant superior vena cava syndrome is often associated with with intrathoracic malignancies. Endovascular management involves placement of a stent across the obstructed SVC. This study examines the safety and efficacy of placing a unilateral balloon expandable covered stent graft that covers the contralateral brachiocephalic vein.

Materials and Methods: Between January 2020 and July 2024 a total of 30 patients (19 men and 11 women; mean age, 66.7 years; range, 42-87 years) with malignant SVC syndrome underwent endovascular management with unilateral balloon expandable covered stent graft placement (Viabahn VBX stent graft) covering the contralateral innominate vein. The presenting symptoms included neck and facial swelling (n =23; 76.7%), bilateral upper extremity swelling (n =17; 57.7%), dyspnea (n=16; 53.3%), unilateral upper extremity swelling (n=9; 30%). SVC reconstruction was completed using 11 mm Viabahn VBX balloon expandable stent grafts that were unilaterally placed within the SVC and across the venous confluence to a patent brachiocephalic vein to relieve venous stenosis or obstruction and prevent tumor overgrowth. The stent grafts were subsequently balloon expanded to 14 mm. Clinical outcomes, survival and patency were assessed.

Results: Balloon expandable covered stent graft placement was technically successful in all patients (n=30, 100%). There were no major complications. Two patients experienced minor access related hematomas (n=2, 6.7%). All 30 (100%) patients experienced complete symptomatic relief in 1-7 days (mean 3.4) after stent graft placement No patients experienced SVC obstruction or contralateral upper extremity venous thrombosis during the follow-up period. Cumulative primary stent patency rates at 1 and 3 months were 100% and 97% respectively.

Conclusion: Unilateral balloon mounted covered stent graft placement covering the contralateral brachiocephalic vein is a safe and effective method for treating malignant SVC syndrome.