Subacute and chronic benign superior vena cava obstructions: Endovascular treatment with self-expanding metallic stents

OBJECTIVE. Our purpose is to report our clinical experience with patients w ho underwent endovascular treatment with Wallstents for subacute or chronic benign obstruction of the superior vena cava (SVC). SUBJECTS AND METHODS. Twelve patients who were an average of 54 +/- 12 year s old were referred for treatment of severe SVC syndrome related to implant ed central venous catheters (n = 8), postradiation fibrosis (n = 2), a perm anent pacemaker (n = 1), or a benign tumor (n = 1). Symptoms were present f or an average of 16 weeks (range, 4-48 weeks) before treatment. Diagnosis o f SVC obstruction was confirmed with helical CT and pretherapeutic phlebogr aphy. Four patients had Stanford's type II stenosis; two, type III; and six , type IV. The mean clinical and radiologic follow-up intervals were 11 mon ths (range, 1-36 months) and 7 months (range, 1 week to 32 months), respect ively. RESULTS. Recanalization was successful in all patients. Fifteen stents were implanted in the 12 patients. Stents were placed after percutaneous balloo n angioplasty in nine patients, and primary stent placement was attempted i n three patients. We immediately achieved a satisfactory SVC diameter in al l patients, whose symptoms were relieved completely within 1 week of stent placement. No technical or clinical complications occurred. SVC syndrome re curred in one patient 2 months after stent placement and was treated by pla cing a second stent. CONCLUSION, Endovascular treatment with stent placement should be considere d relevant and safe for refractory benign SVC syndrome. However, a larger s eries and a longer follow-up period are needed to define the role of stent placement for this syndrome.