Sfyroeras G S, Antonopoulos C N, Mantas G, Moulakakis K G, Kakisis J D, Brountzos E, Lattimer C R, Geroulakos G
Department of Vascular Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
Department of Vascular Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
Eur J Vasc Endovasc Surg. 2017 Feb;53(2):238-254. doi: 10.1016/j.ejvs.2016.11.013. Epub 2016 Dec 19.
The widespread use of central venous catheters, ports, pacemakers, and defibrillators has increased the incidence of benign superior vena cava syndrome (SVCS). This study aimed at reviewing the results of open and endovascular treatment of SVCS.
Medical literature databases were searched for relevant studies. Studies with more than five adult patients, reporting separate results for the SVC were included. Nine studies reported the results of endovascular treatment of SVCS including 136 patients followed up for a mean of 11-48 months. Causes of SVCS were central venous catheters and pacemakers (80.6%), mediastinal fibrosis (13.7%), and other (5.6%). Percutaneous transluminal angioplasty (PTA) and stenting was performed in 73.6%, PTA only in 17.3%, and thrombolysis, PTA, and stenting in 9%. Four studies reported the results of open repair of SVCS including 87 patients followed up between 30 months and 10.9 years. The causes were mediastinal fibrosis (58.4%), catheters and pacemakers (28.5%), and other (13%). Operations performed included a spiral saphenous interposition graft, other vein graft, PTFE graft, and human allograft. Thirteen patients required re-operations (15%) before discharge mainly for graft thrombosis.
In the endovascular group technical success was 95.6%. Thirty day mortality was 0%. Regression of symptoms was reported in 97.3%. Thirty-two patients (26.9%) underwent 58 secondary procedures. In the open group the 30 day mortality was 0%. Symptom regression was reported in 93.5%. Twenty-four patients (28.4%) underwent a total of 33 secondary procedures.
Endovascular is the first line treatment for SVCS caused by intravenous devices, whereas surgery is most often performed for mediastinal fibrosis. Both treatments show good results regarding regression of the symptoms and mid-term primary patency, with a significant incidence of secondary interventions.
中心静脉导管、植入式静脉输液港、起搏器及除颤器的广泛应用增加了良性上腔静脉综合征（SVCS）的发病率。本研究旨在回顾开放性手术及血管腔内治疗SVCS的结果。
检索医学文献数据库以查找相关研究。纳入成年患者超过5例且单独报告上腔静脉治疗结果的研究。9项研究报告了血管腔内治疗SVCS的结果，共136例患者，平均随访11 - 48个月。SVCS的病因包括中心静脉导管及起搏器（80.6%）、纵隔纤维化（13.7%）及其他（5.6%）。73.6%的患者接受了经皮腔内血管成形术（PTA）及支架置入术，17.3%仅接受了PTA，9%接受了溶栓、PTA及支架置入术。4项研究报告了开放性修复SVCS的结果，共87例患者，随访时间为30个月至10.9年。病因包括纵隔纤维化（58.4%）、导管及起搏器（28.5%）及其他（13%）。手术方式包括螺旋大隐静脉移植、其他静脉移植、聚四氟乙烯（PTFE）移植及同种异体移植。13例患者（15%）在出院前需要再次手术，主要原因是移植血管血栓形成。
血管腔内治疗组技术成功率为95.6%。30天死亡率为0%。97.3%的患者症状缓解。32例患者（26.9%）接受了58次二次手术。开放性手术组30天死亡率为0%；93.5%的患者症状缓解。24例患者（28.4%）共接受了33次二次手术。
血管腔内治疗是静脉内装置所致SVCS的一线治疗方法，而手术治疗最常用于纵隔纤维化。两种治疗方法在症状缓解及中期原发性通畅方面均显示出良好效果，但二次干预发生率较高。
