Malignant superior vena cava obstruction: Stent placement via the subclavian route

Over a 3-year period 23 patients with malignant superior vena cava obstruct ion were referred for interventional management. They underwent repeat loca lized central venography and deployment of self-expanding Wallstents. All p atients (age range 26-89 years) were approached by the subclavian route usi ng 29 stents. The stent was used to exclude thrombus in the contralateral b rachiocephalic vein in five patients and histologic information was availab le in all patients. Retrospective analysis of the clinical records was used to assess symptom-free survival and symptom recurrence. All patients reported an improvement in symptoms within 24hr of the procedu re. There was 100% technical success. Primary clinical success was achieved in 19 of 23 patients followed-up to their death with no symptom recurrence (range 1-34, mean 15 weeks). In four patients symptoms recurred but only o ne patient was referred for re-intervention, which was successful. Complica tions included single cases of early post-stent rethrombosis, distal slip o n deployment, and distal slip on balloon dilatation. There were no puncture -related complications.