Majumdar Shamaita, Shoela Ramy, Kim David J, Ramaswamy Raja, Mani Naganathan, Salter Amber, Akinwande Olaguoke
1 Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA.
Vasc Endovascular Surg. 2018 Apr;52(3):202-206. doi: 10.1177/1538574418757401. Epub 2018 Feb 12.
To assess the outcomes of endovascular management for superior vena cava (SVC) syndrome secondary to fibrosing mediastinitis (FM).
Between January 2004 and December 2016, 10 consecutive patients with endovascularly managed SVC syndrome secondary to FM were identified in an institutional database. Venograms were performed to assess the severity and location of the lesion and allow measurement for stent selection. Standard stenting and angioplasty techniques were utilized to establish luminal patency. The safety, feasibility, clinical success, and the primary and secondary patency were evaluated. Kaplan-Meier survival analysis was used to determine median duration of stent patency. A log-rank test was used to test differences in prior stent use.
Our cohort was predominantly female (7/10) with an average age of 42.2 years. Of the 10 patients, 3 had undergone endovascular stenting at an outside institution prior to referral to our institution due to new, recurrent, or worsening symptoms. All patients underwent venography demonstrating stenosis (8/10) or occlusion (2/10) at initial presentation. Stenting or angioplasty was technically successful in 9 (90.0%) patients. Eight of 10 patients had primary stenting, while 1 achieved vascular patency and symptom resolution with angioplasty alone. Median duration of primary patency was 31.3 months (95% confidence interval: 5.9-103). Six (54.5%) patients required secondary revision procedures. Median duration of secondary patency was 6.1 months, with 25% of revisions occurring by 4 months and 75% occurring by 20.9 months. All treated patients (9/9) reported symptomatic relief at 1-month follow-up, establishing a clinical success rate of 100%. There were no 30-day adverse effects related to the procedure.
This study demonstrates that endovascular therapy is a safe and feasible approach for managing FM-related SVC syndrome.
评估血管内治疗纤维性纵隔炎（FM）继发上腔静脉（SVC）综合征的疗效。
在2004年1月至2016年12月期间，从机构数据库中确定了10例连续接受血管内治疗的FM继发SVC综合征患者。进行静脉造影以评估病变的严重程度和位置，并为支架选择提供测量依据。采用标准的支架置入和血管成形术技术来建立管腔通畅。评估安全性、可行性、临床成功率以及初次和二次通畅情况。采用Kaplan-Meier生存分析来确定支架通畅的中位持续时间。使用对数秩检验来检验先前支架使用情况的差异。
我们的队列主要为女性（7/10），平均年龄42.2岁。10例患者中，3例因新出现、复发或症状加重在转诊至我们机构之前已在外部机构接受过血管内支架置入术。所有患者均接受静脉造影，初始表现为狭窄（8/10）或闭塞（2/10）。支架置入或血管成形术在9例（90.0%）患者中技术成功。10例患者中有8例行初次支架置入，而1例仅通过血管成形术实现了血管通畅和症状缓解。初次通畅的中位持续时间为31.3个月（95%置信区间：5.9 - 103）。6例（54.5%）患者需要二次翻修手术。二次通畅的中位持续时间为6.1个月，4个月内发生25%的翻修，20.9个月内发生75%的翻修。所有接受治疗的患者（9/9）在1个月随访时报告症状缓解，临床成功率为100%。未出现与手术相关的30天不良反应。
本研究表明血管内治疗是管理FM相关SVC综合征的一种安全可行的方法。
