Results of Endovascular Treatment of Superior and Inferior Vena Cava at Mid-Term Follow-Up (Up to 65 Moths) Volume 53- Issue 3

Iveta Tasheva* and Lubomir Dosev

• Hospital SofiaMed, Sofia University, Bulgaria

Received: August 28, 2023; Published: October 26, 2023

*Corresponding author: Iveta Tasheva, PhD, Hospital SofiaMed, Sofia University, Bulgaria

DOI: 10.26717/BJSTR.2023.53.008411

Abstract PDF

Aim: The aim of this study is to report our experience in endovascular treatment of superior and inferior vena cava syndrome.

Methods: Between June 2013 and August 2019, 52 patients (mean age 54.75 years; minimum 20yo, maximum 81yo) were endovascularly treated with self-expandable stents of stenosed superior (78.8% - 41 pts) or inferior (21.2% - 11 pts) vena cava. All patients presented with vena cava obstruction syndrome. Complete occlusion was found in 30.8% - 16pts and mean percent of stenosis was 89.92%. The two main causes of the caval obstructions were carcinoma (82.7%, 43pts) and thrombophilia (7.7%, 4 pts) (Figure 1).

Figure 1

• Treatment and complications Successful procedures were 97.8%.

• Balloon predilataion.

• Stent placement – self expandable stents (Sinus XL, Protégé, Abre).

• Balloon postdilation.

• Two major complications (3.8%).

• Thrombus migration causing pulmonary embolism (Figure 2).

Figure 2

Both of them treated endovascularly with thrombus fragmentation, local fibrinolysis and aspiration. In nearly all patients stents were placed (97.8%) and there was clinical improvement of the caval syndrome- considerable reduction of edema and symptom relief in the treated patients. Of all 52 procedures we had two major intra-procedural complications (3.8%) – both migration of thrombus material causing pulmonary embolism, which was treated with intrapulmonary thrombus fragmentation and thrombolysis. All patients were clinically followed-up; 59.6% were followed-up by CT scan or flow Doppler ultrasound up to 65 months after procedure, with a median follow up period of 1 month (30-1950 days). Stent patency was 93.5% (29 pts); significant stent restenosis or occlusion were found in 2 cases (6.5%) and were successfully treated endovascularly (Figure 3).

• All patients had relief of vena cava syndrome.

• All patients were clinically followed up – up to 65 months.

• Median follow up period was 1 month (30-1950 days).

• CT - scan or Doppler ultrasound follow up was done in 59.6% of patients (Figure 4) [1-4].

Figure 3

Figure 4

Endovascular treatment with stent implantation for superior and inferior vena cava syndrome is a minimal invasive and safe procedure with favorable clinical effect and satisfactory mid-term result.

1. Petrov I, Tasheva I (2018) UMBAL Ajibadem City Clinic. Cardiovascular Center, Sofia, Bulgaria.
2. Zimmerman S, Davis M (2018) Rapid Fire: Superior Vena Cava Syndrome. Emerg Med Clin North Am 36: 577-584.
3. Carmo J, Santos A (2018) Chronic Occlusion of the Superior Vena Cava. N Engl J Med 379: 2.
4. Nakano T, Endo S, Kanai Y, Otani S, Tsubochi H, et al. (2014) Surgical outcomes after superior vena cava reconstruction with expanded polytetrafluoroethylene grafts. Ann Thorac Cardiovasc Surg 2: 310-315.