TREATMENT OF MALIGNANT OBSTRUCTION OF THE SUPERIOR VENA-CAVA WITH THESELF-EXPANDING WALLSTENT

Background - Obstruction of the superior vena cava (SVC) in malignant disease can cause considerable distress to patients. Symptomatic relie f can be achieved by the percutaneous implantation of a self-expanding stent (Wallstent) into the stenosis. Methods - Fourteen patients with obstruction of the SVC were treated with one to three Wallstent endop rostheses. They suffered from advanced bronchogenic carcinoma (n=12), thyroid carcinoma (n=1), and breast carcinoma (n=1). The indication fo r stent placement was symptomatic obstruction of the SVC and incurable disease. Stenting was performed for symptom relief, and before, durin g, and after courses of radiotherapy or chemotherapy as needed. Result s - Twelve patients experienced complete symptomatic relief within two days of stent placement. Two patients did not benefit. Three patients not given anticoagulation developed stent thrombosis between one week and eight months after initial placement, and within one day of endob ronchial stent implantation with bronchial laser therapy or balloon di latation in all three. Pateney of the SVC was achieved again by a repe at procedure. Conclusions - Stent placement for obstruction of the SVC gives rapid symptomatic relief. Subsequent endobronchial stent implan tation with bronchial laser therapy or balloon dilatation could be a r isk for caval stent occlusion. Stent thrombosis remains a problem in p atients who are not anticoagulated.