Haddad Mustafa M, Thompson Scott M, McPhail Ian R, Bendel Emily C, Kalra Manju, Stockland Andrew H, Neidert Newton B, Andrews James C, Misra Sanjay, Bjarnason Haraldur, Neisen Melissa J
Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
J Vasc Interv Radiol. 2018 Dec;29(12):1741-1747. doi: 10.1016/j.jvir.2018.07.020. Epub 2018 Nov 3.
To identify whether symptom relief and stent patency vary with use of long-term anticoagulation after stent placement for benign superior vena cava (SVC) syndrome.
Patients with benign SVC syndrome treated with stent placement between January 1999 and July 2017 were retrospectively identified (n = 58). Average age was 49 years (range, 24-80 y); 34 (58%) were women, and 24 (42%) were men. Average follow-up was 2.4 years (range, 0.1-11.1 y, SD 2.6). Of cases, 37 (64%) were due to a long-term line/pacemaker, and 21 (36%) were due to fibrosing mediastinitis. After stent placement, 36 (62%) patients were placed on long-term anticoagulation, and 22 (38%) were not placed on anticoagulation. Percent stenosis was evaluated on follow-up imaging by dividing smallest diameter of the stent by a normal nonstenotic segment of the stent and multiplying by 100.
Technical success was achieved in all cases. There was no significant difference in number of patients who reported a return of symptoms characteristic of benign SVC syndrome between the anticoagulated (16 of 36; 44.4%) and nonanticoagulated (11 of 22; 50%) groups (P = .68). There was no significant difference in the mean percent stenosis between the anticoagulated (40.4% ± 34.7% [range, 0-100%]) and nonanticoagulated (32.1% ± 29.2% [range, 1.7%-100%]) groups (P = .36). No significant difference was found in the time (days) between date of procedure and date of return of symptoms (anticoagulated, 735.9 d ± 1,003.1 [range, 23-3,851 d]; nonanticoagulated, 478 d ± 826.6 [range, 28-2,922 d]) (P = .49). There was no difference in primary patency between groups (P = .59). Finally, 1 patient (2.8%) in the anticoagulated group required surgical intervention, whereas none in the nonanticoagulated group required surgical intervention.
No significant difference was observed in clinical and treatment outcomes in patients who did and did not receive anticoagulation after stent placement for benign SVC syndrome. Management of benign SVC syndrome after stent placement may not require anticoagulation if confirmed by additional studies.
确定在良性上腔静脉（SVC）综合征支架置入术后长期抗凝治疗是否会影响症状缓解及支架通畅情况。
回顾性纳入1999年1月至2017年7月间接受支架置入治疗的良性SVC综合征患者（n = 58）。平均年龄49岁（范围24 - 80岁）；女性34例（58%），男性24例（42%）。平均随访时间2.4年（范围0.1 - 11.1年，标准差2.6）。其中37例（64%）病因是长期留置导管/起搏器，21例（36%）病因是纤维性纵隔炎。支架置入术后，36例（62%）患者接受长期抗凝治疗，22例（38%）未接受抗凝治疗。通过将支架最小直径除以支架正常无狭窄段直径并乘以100，在随访影像上评估狭窄百分比。
所有病例均取得技术成功。抗凝组（36例中的16例，44.4%）和未抗凝组（22例中的11例，50%）中报告出现良性SVC综合征特征性症状复发的患者数量无显著差异（P = 0.68）。抗凝组（40.4% ± 34.7% [范围0 - 100%]）和未抗凝组（32.1% ± 29.2% [范围1.7% - 100%]）的平均狭窄百分比无显著差异（P = 0.36）。手术日期与症状复发日期之间的时间（天）无显著差异（抗凝组，735.9天 ± 1,003.1 [范围23 - 3,851天]；未抗凝组，478天 ± 826.6 [范围28 - 2,922天]）（P = 0.49）。两组之间的初始通畅率无差异（P = 0.59）。最后，抗凝组有1例患者（2.8%）需要手术干预，而未抗凝组无患者需要手术干预。
对于良性SVC综合征支架置入术后接受和未接受抗凝治疗的患者，临床及治疗结果未观察到显著差异。如果更多研究证实，良性SVC综合征支架置入术后的管理可能无需抗凝治疗。
