Ferro C, Scarrone A, Borrelli M, Buccheri G, Ferrigno D, Marchetti G, Russi E, Perona F, Barile A
Servizio di Radiologia, Ospedale S. Croce-Carle, Cuneo.
Radiol Med. 1995 Oct;90(4):457-62.
This study was aimed at verifying the feasibility of stent placement in superior vena cava syndrome (SVCS). From April, 1993, to February 1995, fifteen patients (12 men, 3 women, age range: 48-72 years, average age: 58 years), were treated for malignant stenoses involving superior vena cava in 9 cases, right innominate vein in 3, left innominate vein in 2 and subclavian veins in 1. All patients had been submitted to CT angiography and digital venography to assess side, length and type of the stenosis. In 6 patients locoregional fibrinolysis (with urokinase) was performed. The stenosis was successfully dilated by balloon catheter and the stent was finally removed. Subclavian and innominate veins stenoses were treated with Wallstent, using brachial approach, while stenoses of superior vena cava required transfemoral catheterization for Gianturco-Rosch "Z" stent placement. A control venogram was performed after stenting, with the evaluation of pre/post stent pressure gradient, and later at 1, 3 and 6 months. The stents were positioned in all patients with immediate technical success; no major complications occurred. Two recurrences were successfully resolved. Radiation and/or medical therapy without vascular disobstruction showed worse results in the treatment of superior vena cava syndrome. The percutaneous placement of self-expandable stents should be not only the therapeutic alternative to surgery but the method of choice in these pathologic conditions.
本研究旨在验证在上腔静脉综合征（SVCS）中放置支架的可行性。从1993年4月至1995年2月，共治疗了15例患者（12例男性，3例女性，年龄范围：48 - 72岁，平均年龄：58岁），其中9例为上腔静脉恶性狭窄，3例为右无名静脉狭窄，2例为左无名静脉狭窄，1例为锁骨下静脉狭窄。所有患者均接受了CT血管造影和数字静脉造影，以评估狭窄的部位、长度和类型。6例患者进行了局部纤维蛋白溶解（使用尿激酶）。狭窄部位通过球囊导管成功扩张，最终移除支架。锁骨下静脉和无名静脉狭窄采用Wallstent支架，经肱动脉途径治疗，而上腔静脉狭窄则需要经股动脉插管放置Gianturco-Rosch“Z”支架。支架置入后进行了对照静脉造影，评估支架置入前后的压力梯度，并在术后1、3和6个月进行复查。所有患者的支架置入均取得了即时技术成功；未发生重大并发症。2例复发患者得到成功解决。在上腔静脉综合征的治疗中，未经血管疏通的放疗和/或药物治疗效果较差。经皮置入自膨式支架不仅应作为手术的替代治疗方法，而且是这些病理情况下的首选方法。
