Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy
Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy
复制标题
DOI：
10.1007/s00270-011-0310-z
复制
发表时间：
2013-02-01
影响因子：
2.9
通讯作者：
Moro-Sibilot, Denis
中科院分区：
文献类型：
--
作者：
Fagedet, Dorothee;Thony, Frederic;Moro-Sibilot, Denis
为探讨自膨式裸支架血管内治疗恶性上腔静脉综合征(SVCS)的疗效，分析影响EVT疗效的相关因素，对1992年8月至2007年12月至2009年2月在本院接受EVT治疗的164例上腔静脉恶性综合征患者进行了回顾分析。血管内治疗包括支架置入前后的血管成形术。我们使用了可自行扩张的裸支架。我们研究了这种治疗的结果，并通过统计分析寻找临床疗效、复发和并发症的预测因素。血管内治疗的临床成功率为95%，早期死亡率可接受(2.4%)。上腔静脉血栓形成是EVT失败的唯一独立因素。使用直径大于16 mm的支架是并发症的预测因素(P=0.008)。随访期内发生并发症21例(12.8%)。复发36例(21.9%)，有效复吸占75%。血管闭塞(P=0.006)、首次相关血栓形成(P=0.006)或使用钢质支架(P=0.004)显著增加了SVCS的复发率。长期的抗凝治疗并不影响复发或并发症的风险。在恶性肿瘤中，使用自膨式裸支架的EVT是一种有效的上腔静脉综合征治疗方法。这些结果促使我们建议在SVCS患者的临床病程中早期使用支架治疗，并避免扩张超过16 mm。
To demonstrate the effectiveness of endovascular treatment (EVT) with self-expandable bare stents for malignant superior vena cava syndrome (SVCS) and to analyze predictive factors of EVT efficacy.Retrospective review of the 164 patients with malignant SVCS treated with EVT in our hospital from August 1992 to December 2007 and followed until February 2009. Endovascular treatment includes angioplasty before and after stent placement. We used self-expandable bare stents. We studied results of this treatment and looked for predictive factors of clinical efficacy, recurrence, and complications by statistical analysis.Endovascular treatment was clinically successful in 95% of cases, with an acceptable rate of early mortality (2.4%). Thrombosis of the superior vena cava was the only independent factor for EVT failure. The use of stents over 16 mm in diameter was a predictive factor for complications (P = 0.008). Twenty-one complications (12.8%) occurred during the follow-up period. Relapse occurred in 36 patients (21.9%), with effective restenting in 75% of cases. Recurrence of SVCS was significantly increased in cases of occlusion (P = 0.01), initial associated thrombosis (P = 0.006), or use of steel stents (P = 0.004). Long-term anticoagulant therapy did not influence the risk of recurrence or complications.In malignancy, EVT with self-expandable bare stents is an effective SVCS therapy. These results prompt us to propose treatment with stents earlier in the clinical course of patients with SVCS and to avoid dilatation greater than 16 mm.