The role of self-expanding vascular stent in superior vena cava syndrome for advanced tumours
The role of self-expanding vascular stent in superior vena cava syndrome for advanced tumours
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DOI：
10.1308/rcsann.2020.7127
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发表时间：
2021-04-01
影响因子：
1.4
通讯作者：
Sapienza, P.
中科院分区：
文献类型：
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作者：
Irace, L.;Martinelli, O.;Sapienza, P.
上级腔静脉（SVC）综合征（SVCS）是一种危及生命的事件，需要及时治疗。目前，血管内支架植入术被提议作为缓解症状的一线治疗。我们评估的有效性，安全性和结果的SVC支架定位在晚期cancer.Methods的患者进行支架定位在SVC的肿瘤从2002年1月至2018年12月的基础上，42例形成这项回顾性研究。收集人口统计学数据、危险因素、相关疾病、根据Kishi提出的评分的症状以及根据Sanford和Doty的SVCS类型。记录轻微和严重并发症。可疑的支架闭塞证实了复发的症状，然后由一个确证性的计算机断层扫描（CT）。结果34例（81%）患者有一个不可切除的肺肿瘤侵入或压缩SVC。5例（12%）患者患有非霍奇金淋巴瘤，3例（7%）患有转移性淋巴结病。19例（45%）患者使用镍钛合金支架（Memotherm（R）），其余23例（55%）患者使用钢支架（Wallstent T）。35例（85%）患者在随访期间因疾病进展死亡，24个月时的总生存率为11%（标准误（SE）=0.058）。13名患者（32%）因支架内血栓形成（3名患者（23%））和不受控制的癌症进展（10名患者（77%））的外源性压迫而发生SVCS复发。在24个月的总体无瘤间隔为57%（SE=0.095）。结论我们建议使用血管内手术作为一线治疗局部晚期或转移性肿瘤中存在SVCS。
Introduction Superior vena cava (SVC) syndrome (SVCS) is a life-threatening occurrence that necessitates prompt treatment. At present, endovascular stenting is proposed as a first-line treatment to relieve symptoms. We assessed the effectiveness, safety and outcome of SVC stent positioning in patients affected with advanced cancer.Methods Forty-two patients undergoing stent positioning in the SVC for neoplasms from January 2002 to December 2018 form the basis of this retrospective study. Demographic data, risk factors, associated diseases, symptoms at presentation according to the score proposed by Kishi and the type of SVCS according to Sanford and Doty were collected. Minor and major complications were recorded. Suspected stent occlusion was confirmed by means of recurrence of symptoms followed by a confirmatory computed tomography (CT).Results Thirty-four (81%) patients had a nonresectable lung tumour invading or compressing the SVC. Five (12%) patients had a non-Hodgkin's lymphoma, and three (7%) had metastatic lymphadenopathies. Nitinol stents (Memotherm (R)) were employed in 19 (45%) patients, and steel stents (Wallstent T) in the remaining 23 (55%) patients. Thirty-five (85%) patients died during follow up for disease progression and the overall survival rate at 24 months was 11% (standard error (SE)=0.058). Thirteen patients (32%) had a recurrence of SVCS because of stent thrombosis in three (23%) and extrinsic compression from uncontrolled cancer progression in ten (77%). The overall symptom-free interval at 24 months was 57% (SE=0.095).Conclusions We recommend the use of the endovascular procedure as a first-line treatment in locally advanced or metastatic tumour in the presence of SVCS.