VENOUS ANGIOPLASTY AND INTRALUMINAL SELF- EXPANDING STENT IMPLANTATION IN EMERGENCY TREATMENT OF SUPERIOR VENA-CAVA OBSTRUCTION BY MALIGNANT-TUMOR

History and clinical findings: A 58-year-old man was hospitalized beca use of threatened asphyxia resulting from massive obstruction to neck vein flow and increased venous markings over the ventral and dorsal th orax. The previous year he had received radiotherapy (total of 55.8 Gy ) for squamous cell carcinoma in the right upper lobe of the lung (pri mary stage T2 N2 MO). The signs of venous congestion had developed ove r several months. Tests: Emergency phlebography demonstrated obstructi on to superior vena cava (SVC) flow by tumour compression. Treatment a nd course: It was possible to pass the SVC obstruction with a hydrophi lic guide-wire and then perform a balloon angioplasty, followed later by implantation of two intraluminal expandable stents (>>Wallstent<<). The dyspnoea quickly improved after the successful recanalization. Th e day after the intervention palliative radiotherapy of the SVC obstru ction was begun. But increased venous markings over the thorax recurre d, but without dyspnoea, after 4 1/2 months free of signs of venous co ngestion. Repeat phlebography again demonstrated complete obstruction of the SVC by the tumour. Recanalization by balloon angioplasty was ag ain achieved. Conclusions: This case underlines the value of percutane ous balloon angioplasty with stent implantation as supplementary treat ment in the late stages of SVC obstruction by tumour.