Azizi Abdul Hussain, Shafi Irfan, Zhao Matthew, Chatterjee Saurav, Roth Stephanie Clare, Singh Maninder, Lakhter Vladimir, Bashir Riyaz
Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, United States.
EClinicalMedicine. 2021 Jun 28;37:100970. doi: 10.1016/j.eclinm.2021.100970. eCollection 2021 Jul.
Superior vena cava (SVC) syndrome is caused by the obstruction of the SVC and can result in significant morbidity and mortality. In contemporary practice, endovascular therapy (ET) has become the standard of care for a majority of these patients. This study is a systematic review and meta-analysis of the available literature to assess technical success, restenosis, and recurrence of SVC syndrome following endovascular intervention.
For this meta-analysis, we conducted a systematic literature review of PubMed, Cochrane Library, and Embase databases from inception to April 14, 2021 for studies on ET for SVC syndrome. Studies included full-length journal articles on the use of ET among adults with SVC syndrome. Case reports or case series with fewer than 20 patients were excluded. We evaluated the endpoints of technical success rate, restenosis rate, and recurrence rates in SVC syndrome patients after endovascular stenting. The results of this study were calculated using random-effects models.
We identified 6,012 reports, of which 39 studies met our inclusion criteria and were included for analysis. A total of 2200 patients received ET for SVC syndrome. The weighted technical success rate was 98.8% (95% CI 98.2-99.3) with low heterogeneity (I=17.4%, = 0.185), restenosis rate was 10.5% (95% CI 8.4-12.6) with moderate heterogeneity (I=53.5%, <0.001), and recurrence rate was 10.8% (95% CI 8.1-13.5) with high heterogeneity (I=75.8%, <0.001). Total complication rate was 8.6% (95% CI 7.3%-9.9%) with a mean complication rate of 7.5% (95% CI 4.7%-10.3%).
Our systematic review revealed high technical success, low restenosis, and low recurrence rates following ET. Collectively, these results support the paradigm of ET as an effective and safe treatment for patients with SVC syndrome.
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上腔静脉（SVC）综合征是由上腔静脉阻塞引起的，可导致严重的发病率和死亡率。在当代实践中，血管内治疗（ET）已成为大多数此类患者的标准治疗方法。本研究是对现有文献的系统评价和荟萃分析，旨在评估血管内介入治疗后SVC综合征的技术成功率、再狭窄率和复发率。
对于这项荟萃分析，我们对PubMed、Cochrane图书馆和Embase数据库进行了系统的文献回顾，涵盖从数据库建立至2021年4月14日关于SVC综合征的血管内治疗的研究。研究包括关于在患有SVC综合征的成年人中使用血管内治疗的完整期刊文章。排除患者少于20例的病例报告或病例系列。我们评估了血管内支架置入术后SVC综合征患者的技术成功率、再狭窄率和复发率终点。本研究结果采用随机效应模型计算。
我们识别出6012份报告，其中39项研究符合我们的纳入标准并被纳入分析。共有2200例患者接受了SVC综合征的血管内治疗。加权技术成功率为98.8%（95%CI 98.2 - 99.3），异质性低（I = 17.4%，P = 0.185），再狭窄率为10.5%（95%CI 8.4 - 12.6），异质性中等（I = 53.5%，P < 0.001），复发率为10.8%（95%CI 8.1 - 13.5），异质性高（I =75.8%，P < 0.001）。总并发症发生率为8.6%（95%CI 7.3% - 9.9%），平均并发症发生率为7.5%（95%CI 4.7% - 10.3%）。
我们的系统评价显示血管内治疗后技术成功率高、再狭窄率低和复发率低。总体而言，这些结果支持血管内治疗作为SVC综合征患者有效且安全的治疗模式。
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