García Mónaco R, Bertoni H, Pallota G, Lastiri R, Varela M, Beveraggi E M, Vassallo B C
Department of Endovascular Therapy, Hospital Italiano de Buenos Aires, Gascón 450, CP 1181 Buenos Aires, Argentina.
Eur J Cardiothorac Surg. 2003 Aug;24(2):208-11. doi: 10.1016/s1010-7940(03)00293-8.
Superior vena cava syndrome (SVCS) is associated to a malignant tumor in more than 90% of cases; being the lung cancer the most frequent (80%). SVCS has a benign cause in less than 5% of cases. Endovascular stenting has been proposed as the primary treatment of choice. We report our experience in SVC recanalization through the use of self-expanding vascular stents as treatment of life-threatening SVCS of benign and malignant etiology.
Between January 1994 and April 2002 44 patients with critical SVCS, were treated at the Hospital Italiano de Buenos Aires. Forty nine self-expanding endovascular metallic stents were percutaneously placed in the SVC. Thirty-one (70%) patients were male and 13 (30%) were female. The mean age was 55.6 years (range: 21-77). The etiology of SVCS was malignant in 40 cases and benign in 4. The malignant causes included lung cancer: 37 (37/44 - 92.5%), lymphoma: 1 (2.5%), chondrosarcoma 1 (2.5%), melanoma 1 (2.5%). The benign etiology corresponded to central catheters (N: 2) and post-radiation fibrosis (N: 2). Cavography showed complete occlusion of SVC in 12 cases (27%) and significant partial stenosis in 32 cases (73%). Thrombi associated with tumor stenosis were present in 25 (57%) patients.
All procedures were technically successful. No stent migration was observed. Thirty-two patients with malignant tumor ultimately died due to the progression of the disease. Mean survival time was 193 days (range: 25-578). SVCS recurrence was observed on six occasions. In four patients a new stent was placed. Symptomatic improvement was dramatically seen within 24-48 h after stent placement in 40 patients (90.9%) and 83.3% out of the cases (38/44) were symptoms-free during the rest of the disease. Three patients died in the 7 following days.
The use of self-expanding vascular endoprostheses in the recanalization treatment of SVC in SVCS due to a malignant or benign etiology offers excellent results with rapid and prolonged remission of symptoms.
超过90%的上腔静脉综合征（SVCS）病例与恶性肿瘤相关；其中肺癌最为常见（80%）。不到5%的SVCS病例病因是良性的。血管内支架置入术已被提议作为首选的主要治疗方法。我们报告了使用自膨式血管支架进行上腔静脉再通治疗良性和恶性病因导致的危及生命的SVCS的经验。
1994年1月至2002年4月期间，布宜诺斯艾利斯意大利医院对44例严重SVCS患者进行了治疗。经皮在上腔静脉置入了49个自膨式血管内金属支架。31例（70%）患者为男性，13例（30%）为女性。平均年龄为55.6岁（范围：21 - 77岁）。SVCS的病因中，40例为恶性，4例为良性。恶性病因包括肺癌：37例（37/44 - 92.5%）、淋巴瘤：1例（2.5%）、软骨肉瘤1例（2.5%）、黑色素瘤1例（2.5%）。良性病因包括中心静脉导管（2例）和放疗后纤维化（2例）。腔静脉造影显示12例（27%）上腔静脉完全闭塞，32例（73%）存在明显的部分狭窄。25例（57%）患者存在与肿瘤狭窄相关的血栓。
所有手术在技术上均获成功。未观察到支架移位。32例患有恶性肿瘤的患者最终因疾病进展死亡。平均生存时间为193天（范围：25 - 578天）。观察到6例SVCS复发。4例患者置入了新的支架。40例患者（90.9%）在支架置入后24 - 48小时内症状明显改善，38例（44例中的83.3%）在疾病后期无症状。3例患者在随后7天内死亡。
使用自膨式血管内假体对恶性或良性病因导致的SVCS进行上腔静脉再通治疗，可取得优异效果，症状能迅速缓解且持续时间长。
