SUPERIOR VENA CAVA STENTING - 06/09/11

Doi : 10.1016/S0033-8389(05)70171-8

Charles D. Yim, MD ^{^{*
Department of Radiology, University of Minnesota School of Medicine, Minneapolis, Minnesota}}, Shekhar S. Sane, MD ^{^{*
Department of Radiology, University of Minnesota School of Medicine, Minneapolis, Minnesota}}, Haraldur Bjarnason, MD ^{^{*
Department of Radiology, University of Minnesota School of Medicine, Minneapolis, Minnesota}}

Résumé

Superior vena cava (SVC) syndrome has a typical presentation such that the clinical diagnosis usually is clear. The diagnosis can be verified with radiologic studies, such as venography, MR imaging, or CT. Doppler ultrasound can also play an important role in the diagnosis of the syndrome. Superior vena cava syndrome is caused by either significant narrowing or occlusion of the SVC, although compromise of the SVC is not necessarily symptomatic. The most frequent symptoms include dyspnea, chest pain, cough, dysphagia, facial swelling, arm swelling, headaches, and cyanosis.

The syndrome is most commonly encountered in patients with malignancy (74% to 95%).^{39Rosch J., Bedell J., Putnam J., et al. Gianturco expandable wire stents in the treatment of superior vena cava syndrome recurring after maximum tolerance radiation Cancer 1987 ; 60 : 1243-1246 [cross-ref]

Cliquez ici pour aller à la section Références} The tumor mass either compresses the vessel or encases it and grows directly into its wall causing obstruction of the SVC. Bronchogenic carcinoma and lymphoma are the malignancies most commonly associated with SVC syndrome. Other causes of SVC syndrome include mediastinal fibrosis, infection, central venous catheters, intravenous pacemaker wires, and aortic aneurysms. The increased use of central venous catheters and the increased length of therapies including bone marrow transplantation have directly influenced the prevalence and diagnosis of the syndrome.

The treatment of SVC syndrome caused by malignancy has traditionally been aggressive radiation therapy or chemotherapy. For benign causes and when radiation or chemotherapy is ineffective, surgery has been the alternative. Surgical bypass has been used successfully but requires a major operation by a sternotomy. The use of endoluminal stents has become another therapeutic option for both malignant and benign causes, because it provides acute relief of the symptoms while allowing the patient to continue therapy for the disease responsible for the syndrome.

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Plan

Address reprint requests to Haraldur Bjarnason, MD, Department of Radiology, University of Minnesota School of Medicine, Box 292 Mayo, 420 Delaware Street, SE, Minneapolis, MN 55455