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Stenting for superor vena cava obstruction

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    Katherine Kozlowski, Medical Contributor to Vein News and www.VeinsVeinsVeins.com

    Zi-Chan Wang and colleagues from Department of Thoracic Surgery, Ningbo First Hospital, Zhejiang, China and Department of Radiology, Xuzhou Central Hospital, Jiangsu, China have investigsted whether covered or uncovered stent insertion achieved better clinical efficacy when used to treat malignant superior vena cava (SVC) obstruction.

    What is superior vena cava obstruction?
    The superior vena cava (SVC) is a large vein that returns blood from the head, neck, arms, and upper thorax (systemic circulation) to the right atrium of the heart.

    Superior vena cava obstruction occurs when this vessel becomes blocked due to external compression (something putting pressure on the vessel from the outside), invasion of the vessel wall by a tumor/growth, or internal obstruction (something on the inside blocking the vessel).

    What causes superior vena cava obstruction? 
    The most common causes of superior vena cava obstruction are malignant cancers, most commonly small cell lung cancer and non-Hodgkin lymphoma. Over recent years, intravascular devices (devices inserted into blood vessels such as stents or catheters) with associated thrombosis have been increasingly causing SVC obstruction.

    About 90% of SVC obstruction cases result from malignant cancers. (Zimmerman & Davis 2018)

    How many patients were investigated in this series? 
    A total of 64 patients with malignant superior vena cava obstruction underwent stent insertion between January 2011 and March 2018.

    34 were treated via uncovered stent insertion.

    30 were treated via covered stent insertion.

    What were the study parameters? 
    The authors compared the clinical effectiveness, patency of the stent, and overall survival between these two groups.

    What were the results of this study?
    Both treatments achieved a 100% technical and clinical success rate, without any incidence of complications relating to the procedure.

    Stent dysfunction was found in one and six patients in the covered and uncovered groups during the follow-up period (1/30 vs. 6/34, p = .153), respectively.

    The covered stent patency period was significantly longer in the group treated with covered stents (374 vs. 317 days, p = .049), while median survival following stent insertion was 175 and 159 days, respectively, for the covered and uncovered groups (p = .784).

    What are the conclusions of this study?
    Uncovered and covered stent insertion are both safe means of effectively treating patients with malignant superior vena cava obstruction, but covered stents achieve better patency for long-term periods than uncovered stents.

    Zimmerman S, Davis M. Rapid Fire: Superior Vena Cava Syndrome. Emerg Med Clin N Am 2018; 36(3):577-584

    Wang ZS, Li CW, Li JX et al. Covered versus uncovered stent insertion for malignant superior vena cava obstruction. Minim Invasive Ther Allied Technol 2020; 29(6): 353-358