Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement.

PURPOSE: To evaluate use of catheter-directed thrombolysis and/or endovascular stent placement to treat superior vena cava (SVC) syndrome.

MATERIALS AND METHODS: Fifty-nine consecutive patients with SVC syndrome were studied. The cause was underlying malignancy in 43 and benign disease in 16. All patients underwent bilateral upper-extremity venography. The SVC was occluded in 31 cases and stenosed in 28. Twenty-seven patients underwent catheter-directed thrombolysis; 51 underwent endovascular stent placement. Patency was defined in terms of absence of symptoms and signs of SVC syndrome.

RESULTS: Technical success was achieved in 56 of 59 patients (95%). Among 42 patients with underlying malignancy (mean follow-up, 7.0 months; range, 1-34 months), primary clinical patency was achieved in 33 (79%) and secondary clinical patency was achieved in 39 (93%). Among 13 patients with benign disease (mean follow-up, 17.0 months; range, 1-27 months), primary clinical patency was achieved in 10 (77%) and secondary clinical patency was achieved in 11 (85%). Four patients were lost to follow-up. Periprocedural mortality and morbidity rates were 3% (two of 59 patients) and 10% (six of 59 patients), respectively.

CONCLUSION: Catheter-directed thrombolysis and endovascular stent placement is a safe and effective treatment for SVC syndrome.