Yevich Steven, Cardenas Nicolas, Sheth Rahul, Kuban Joshua, Patel Milan, Shah Ketan, Pal Koustav, Chen Stephen R, Tam Alda
Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Radiology, University of Texas Health Science Center at Houston, Houston, TX, USA.
Mediastinum. 2024 May 17;8:45. doi: 10.21037/med-22-43. eCollection 2024.
The mediastinal vasculature can be affected by various etiologies in cancer patients. Both direct and indirect sequela of cancer may result in life-threatening clinical presentations. Tumor growth may cause vessel narrowing and decreased blood flow from either extrinsic mass effect, invasion into the vascular wall, or tumor thrombus within the lumen. In addition, cancer patients are predisposed to indirect sequela to the mediastinal vasculature from an increased risk of benign thromboembolic events, tumor thrombus, or iatrogenic complications during cancer treatments. Benign thrombus may result in partial or complete occlusion of the superior vena cava (SVC) or pulmonary artery. Vascular damage such as pseudoaneurysm or stricture may result from iatrogenic complications from radiation therapy, surgery, or other interventions. The clinical presentation of the vascular compromise is dictated by the vascular anatomical structure that is affected and the type of injury. In the appropriate clinical scenario, endovascular treatments may be pursued. These minimally invasive procedures include balloon venoplasty and angioplasty, stent placement, catheter-directed thrombolysis, embolectomy, and embolization. This review discusses the most common endovascular interventions for vascular compromise based on the great vessel affected: the SVC, pulmonary artery, pulmonary vein, bronchial arteries, or the aorta and supra-aortic arteries. Indications for treatment are discussed, with particular attention to disease etiology and clinical presentation.
癌症患者的纵隔血管系统可能受到多种病因的影响。癌症的直接和间接后果都可能导致危及生命的临床表现。肿瘤生长可能由于外在肿块效应、侵犯血管壁或管腔内肿瘤血栓而导致血管狭窄和血流减少。此外，癌症患者由于良性血栓栓塞事件、肿瘤血栓或癌症治疗期间医源性并发症的风险增加，易发生纵隔血管系统的间接后果。良性血栓可能导致上腔静脉（SVC）或肺动脉部分或完全闭塞。血管损伤如假性动脉瘤或狭窄可能源于放射治疗、手术或其他干预的医源性并发症。血管受损的临床表现取决于受影响的血管解剖结构和损伤类型。在适当的临床情况下，可采用血管内治疗。这些微创手术包括球囊静脉成形术和血管成形术、支架置入、导管定向溶栓、栓子切除术和栓塞术。本综述讨论了基于受影响的大血管（即SVC、肺动脉、肺静脉、支气管动脉或主动脉和主动脉弓上动脉）对血管受损进行的最常见血管内干预。讨论了治疗指征，特别关注疾病病因和临床表现。
