Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA; The Deep Vein Institute, University of Washington, Seattle, WA.
Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA.
J Vasc Surg Venous Lymphat Disord. 2022 Nov;10(6):1279-1287.e1. doi: 10.1016/j.jvsv.2022.05.008. Epub 2022 Jul 15.
In the present study, we evaluated the technical and clinical outcomes of thoracic central vein reconstruction for superior vena cava (SVC) syndrome using kissing Viabahn VBX stent grafts (W.L. Gore & Associates, Flagstaff, AZ).
All adult patients with SVC syndrome who had undergone attempted bilateral brachiocephalic vein-to-SVC reconstruction using kissing VBX stent grafts at an academic hospital between August 2019 and February 2021 were reviewed. The technical results, adverse events, imaging follow-up findings, and clinical outcomes were recorded. Patency over time was assessed using Kaplan-Meier analysis.
A total of 28 patients (16 women and 12 men; mean age, 52.0 years) constituted the study cohort. Of the 28 patients, 17 (60.7%) had had benign and 11 (39.3%) malignant etiologies. The presenting symptoms included neck swelling (n = 17; 60.7%), bilateral upper extremity swelling (n = 15; 53.6%), dyspnea (n = 7; 25%), unilateral upper extremity swelling (n = 4; 14.3%), and dysphagia (n = 1; 3.6%). SVC reconstruction with VBX stent grafts in a kissing configuration was successfully completed in 27 of the 28 patients (96.4%). Four major adverse events were noted in the benign etiology subgroup (23.5%), including intraprocedural hemopericardium (n = 3) and delayed pneumothorax (n = 1). Of the 28 patients, 27 (96.4%) had experienced resolution of their presenting symptoms. The mean clinical follow-up for the living patients was 358.8 ± 77.2 days (range, 78-645 days). The mean imaging follow-up for the living patients was 272.6 ± 91 days (range, 26-594 days). The primary, primary-assisted, and secondary patency rates at 12 months were 71.8%, 88.8%, and 100%, respectively.
For the management of SVC syndrome, thoracic central vein reconstruction with kissing VBX stent grafts was feasible with a high rate of symptom resolution and acceptable patency. However, this technique should not be recommended for those with benign SVC syndrome owing to the high risk of cardiac tamponade.
在本研究中，我们评估了使用吻合法 Viabahn VBX 支架移植物（戈尔公司，Flagstaff，AZ）重建胸中心静脉治疗上腔静脉（SVC）综合征的技术和临床结果。
回顾了 2019 年 8 月至 2021 年 2 月期间在一家学术医院接受双侧头臂静脉至 SVC 重建的 SVC 综合征成年患者，使用吻合法 VBX 支架移植物。记录技术结果、不良事件、影像学随访结果和临床结果。使用 Kaplan-Meier 分析评估随时间的通畅率。
共有 28 例患者（16 名女性和 12 名男性；平均年龄 52.0 岁）构成研究队列。28 例患者中，17 例（60.7%）为良性病因，11 例（39.3%）为恶性病因。主要症状包括颈部肿胀（n=17；60.7%）、双侧上肢肿胀（n=15；53.6%）、呼吸困难（n=7；25%）、单侧上肢肿胀（n=4；14.3%）和吞咽困难（n=1；3.6%）。28 例患者中，27 例（96.4%）成功完成了 VBX 支架移植物吻合法重建 SVC。良性病因亚组中有 4 例（23.5%）发生了 4 例主要不良事件，包括术中心包积血（n=3）和迟发性气胸（n=1）。28 例患者中，27 例（96.4%）的症状得到缓解。对存活患者的平均临床随访时间为 358.8±77.2 天（范围，78-645 天）。对存活患者的平均影像学随访时间为 272.6±91 天（范围，26-594 天）。12 个月时的主要、主要辅助和次要通畅率分别为 71.8%、88.8%和 100%。
对于 SVC 综合征的治疗，使用吻合法 VBX 支架移植物重建胸中心静脉是可行的，症状缓解率高，通畅率可接受。然而，由于心脏压塞的风险较高，该技术不推荐用于良性 SVC 综合征患者。
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