COMPARISON OF OPERATIVE RECONSTRUCTION AND PERCUTANEOUS BALLOON DILATION FOR CENTRAL VENOUS OBSTRUCTION

To evaluate the efficacy of venous reconstruction versus percutaneous transluminal angioplasty for the treatment of obstruction of the super ior vena cava and its major tributaries, we retrospectively reviewed t he clinical course of 27 patients, of whom 13 underwent operative reco nstruction and 15 had angioplasty (1 had both). Three patients had obs truction of the superior vena cava, 8 had occlusion of the innominate veins, and 16 had obstruction of the subclavian or axillary veins. In both treatment groups, mean age, indications, etiology, and location o f the lesion were comparable. No major surgical complications occurred ; one patient who underwent angioplasty experienced stent migration to the pulmonary artery without sequelae. Primary symptomatic relief at 1 year was achieved in 88% in the surgical group versus 36% in the ang ioplasty group (p <0.05 by Fisher's exact test) and at 2 years in 71% versus 0%, respectively (p <0.01). One- and 2-year success rates with repeated angioplasty, however, were 86% and 66% (p >0.9), respectively . We conclude that the long-term success rate of operative reconstruct ion exceeds that of single percutaneous transluminal angioplasty. Howe ver, with repeated angioplasty, success rates approach those of operat ive reconstruction.