Halloul Z, Weber M, Ricke J, Smith B, Meyer F
Division of Vascular Surgery, Department of Surgery, University Hospital, Magdeburg, 39120 Magdeburg, Germany.
Thorac Cardiovasc Surg. 2009 Oct;57(7):427-31. doi: 10.1055/s-0029-1185880. Epub 2009 Sep 30.
The aim of this study was to compare the outcome of a novel hybrid technique with the results of conventional approaches when treating tumor-induced superior vena cava syndrome (SVCS). The failure of a thrombectomy via transjugular aspiration led to an interdisciplinary approach to treat malignant SVCS.
The technique is relatively unknown but is performable if vascular surgeons and interventional radiologists work side by side in the operating room. We give an in-depth description of the hybrid technique, including surgical thrombectomy of the SVC, left brachiocephalic vein and left subclavian vein, occlusion balloon placement, stenting of the SVC and left brachiocephalic vein and the imaging controls. The equipment needed for this approach must be in the operating room and may only be available in bigger hospitals.
Tumor-induced SVCS is an urgent case that sometimes cannot wait for radiotherapy or chemotherapy to reduce the tumor mass compressing the SVC. The results of our hybrid technique included almost complete relief of SVCS symptoms within 24 hours. The patient was discharged two days after surgery.
Treatment provided the advantages associated with limited invasiveness, i.e., a faster and complication-free recovery period. The procedure may be a suitable alternative to open surgical intervention, as it involves less invasive trauma and has a reasonable risk-benefit ratio with a good chance of technical and clinical success. Further studies are warranted to better assess the complication rates with this hybrid technique.
本研究的目的是比较一种新型混合技术与传统方法治疗肿瘤引起的上腔静脉综合征（SVCS）的效果。经颈静脉抽吸进行血栓切除术失败后，采用了多学科方法治疗恶性SVCS。
该技术相对鲜为人知，但如果血管外科医生和介入放射科医生在手术室并肩协作，是可以实施的。我们对混合技术进行了深入描述，包括上腔静脉、左头臂静脉和左锁骨下静脉的手术血栓切除术、封堵球囊置入、上腔静脉和左头臂静脉支架置入以及影像学检查。这种方法所需的设备必须在手术室配备，可能只有较大的医院才有。
肿瘤引起的SVCS是一种紧急情况，有时不能等待放疗或化疗来缩小压迫上腔静脉的肿瘤肿块。我们的混合技术的结果包括在24小时内几乎完全缓解SVCS症状。患者术后两天出院。
该治疗方法具有微创相关的优势，即恢复期更快且无并发症。该手术可能是开放手术干预的合适替代方法，因为它涉及的创伤较小，风险效益比合理，技术和临床成功的机会较大。有必要进行进一步研究以更好地评估这种混合技术的并发症发生率。
