Endovascular stent-based revascularization of malignant superior vena cava syndrome with concomitant implantation of a port device using a dual venous approach
Endovascular stent-based revascularization of malignant superior vena cava syndrome with concomitant implantation of a port device using a dual venous approach
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DOI：
10.1007/s00520-017-3997-9
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发表时间：
2018-06-01
影响因子：
3.1
通讯作者：
Goltz, J. P.
中科院分区：
文献类型：
--
作者：
Anton, Susanne;Oechtering, T.;Goltz, J. P.
本文旨在评价恶性上级腔静脉综合征（SVCS）血管内血运重建术的安全性和有效性，同时采用双静脉入路植入完全植入式静脉输液港（TIVAP）。31例（平均年龄67 +/- 8岁），患有恶性CVO，通过植入自体经股动脉入路将支架扩张至上级腔静脉（SVC）（Sinus XLA（R），OptiMed，德国; n = 11 [组1]和Prot，g，（TM）EverFlex，Covidien，爱尔兰; n = 20 [组2]）。同时，通过锁骨下静脉经皮穿刺（a）从上方探查病变，（B）促进穿透操作，（c）植入TIVAP。关于SVC综合征的主要终点是技术（残余狭窄< 30%）和临床（症状缓解）成功;关于TIVAP植入，技术成功定义为功能导管在SVC内的定位。次要终点是并发症以及支架和TIVAP通畅率。SVS血运重建的技术和临床成功率为100%，TIVAP植入的技术和临床成功率为100%。确定了1例穿刺部位血肿（轻微并发症，第2天）和1例输液港-导管相关败血症（严重并发症，第18天）。平均导管天数为313 +/- 370天。平均影像学随访时间为184 ± 172天。第1组在3、6和12个月时的估计通畅率为100%，第2组为84、84和56%（p = 0.338）。使用双静脉入路对恶性SVCS进行基于支架的血运重建并同时植入输液港器械似乎是安全有效的。
The aim of this paper is to evaluate the safety and efficacy of endovascular revascularization of malignant superior vena cava syndrome (SVCS) and simultaneous implantation of a totally implantable venous access port (TIVAP) using a dual venous approach.Retrospectively, 31 patients (mean age 67 +/- 8 years) with malignant CVO who had undergone revascularization by implantation of a self-expanding stent into the superior vena cava (SVC) (Sinus XLA (R), OptiMed, Germany; n = 11 [Group1] and Prot,g, (TM) EverFlex, Covidien, Ireland; n = 20 [Group 2]) via a transfemoral access were identified. Simultaneously, percutaneous access via a subclavian vein was used to (a) probe the lesion from above, (b) facilitate a through-and-through maneuver, and (c) implant a TIVAP. Primary endpoints with regard to the SVC syndrome were technical (residual stenosis < 30%) and clinical (relief of symptoms) success; with regard to TIVAP implantation technical success was defined as positioning of the functional catheter within the SVC. Secondary endpoints were complications as well as stent and TIVAP patency.Technical and clinical success rate were 100% for revascularization of the SVS and 100% for implantation of the TIVAP. One access site hematoma (minor complication, day 2) and one port-catheter-associated sepsis (major complication, day 18) were identified. Mean catheter days were 313 +/- 370 days. Mean imaging follow-up was 184 +/- 172 days. Estimated patency rates at 3, 6, and 12 months were 100% in Group 1 and 84, 84, and 56% in Group 2 (p = 0.338).Stent-based revascularization of malignant SVCS with concomitant implantation of a port device using a dual venous approach appears to be safe and effective.