Pneumologie 2013; 67(10): 573-579
DOI: 10.1055/s-0033-1344490
Fallbericht
© Georg Thieme Verlag KG Stuttgart · New York

Interventionelle Behandlung des akuten und subakuten Vena-cava-superior-Syndroms

Interventional Treatment of the Acute and Subacute Vena Cava Superior Syndrome
J.-P. Kühn
1   Institut für Diagnostische Radiologie und Neuroradiologie, Ernst-Moritz-Arndt Universität Greifswald
,
B. Mensel
1   Institut für Diagnostische Radiologie und Neuroradiologie, Ernst-Moritz-Arndt Universität Greifswald
,
R. Ewert
2   Institut für Innere Medizin, Abteilung Pulmologie, Ernst-Moritz-Arndt Universität Greifswald
,
T. Bollmann
2   Institut für Innere Medizin, Abteilung Pulmologie, Ernst-Moritz-Arndt Universität Greifswald
› Author Affiliations
Further Information

Publication History

eingereicht11 June 2013

akzeptiert nach Revision04 July 2013

Publication Date:
02 September 2013 (online)

Zusammenfassung

Hintergrund: Infolge eines fehlenden zentralvenösen Abflusses über die obere Hohlvene kann das Vena-cava-superior-Syndrom (VCSS) eine lebensgefährliche Situation darstellen. Ein schnelles und effektives Therapiekonzept ist entscheidend.

Methode: Anhand von zwei Fallberichten wird die endovaskuläre Stenttherapie zur Behandlung des akuten und subakuten VCSS erläutert und diskutiert.

Ergebnisse: Im ersten Fall berichten wir über einen Patienten mit akuter Dyspnoe durch eine obere Einflussstauung bei Dekompensation einer chronischen Thrombose der Vena cava superior. Im zweiten Fall mit gleicher Akutsymptomatik lag eine tumorbedingte Kompression der Vena cava superior vor. Die Akutsituation der VCSS konnte bei beiden Patienten mittels Stentimplantation therapiert werden.

Schlussfolgerung: Die endovaskuläre Therapie des akuten VCSS stellt eine effektive Therapieoption dar.

Abstract

Background: Superior vena cava syndrome is defined as the lack of central venous inflow through the superior vena cava and can present a life-threatening situation. The acute situation is characterized by dyspnea and requires a fast and effective treatment.

Methods: Using two case reports, endovascular stent therapy for the treatment of acute and subacute superior vena cava syndrome is explained and discussed.

Results: In the first case, we introduce a patient with acute dyspnea due to decompensation of a chronic thrombosis of the superior vena cava. The second case displayed the same acute symptoms consisting of acute dyspnea and upper venous congestion due to a tumor-related compression of the superior vena cava. In both cases, the acute situation of superior vena cava syndrome was successfully treated by stent implantation.

Conclusion: Endovascular treatment of superior vena cava syndrome is an effective option with a high technical success rate.

 
  • Literatur

  • 1 Ostler PJ, Clarke DP, Watkinson AF et al. Superior vena cava obstruction: a modern management strategy. Clin Oncol (R Coll Radiol) 1997; 9: 83-89
  • 2 Armstrong BA, Perez CA, Simpson JR et al. Role of irradiation in the management of superior vena cava syndrome. Int J Radiat Oncol Biol Phys 1987; 13: 531-539
  • 3 Davenport D, Ferree C, Blake D et al. Radiation therapy in the treatment of superior vena caval obstruction. Cancer 1978; 42: 2600-2603
  • 4 Dyet JF, Moghissi K. Role of venography in assessing patients with superior caval obstruction caused by bronchial carcinoma for bypass operations. Thorax 1980; 35: 628-630
  • 5 Sculier JP, Feld R. Superior vena cava obstruction syndrome: recommendations for management. Cancer Treat. Rev 1985; 12: 209-218
  • 6 Cengiz K, Aykin A, Demirci A et al. Intrathoracic goiter with hyperthyroidism, tracheal compression, superior vena cava syndrome, and Horner's syndrome. Chest 1990; 97: 1005-1006
  • 7 Abner A. Approach to the patient who presents with superior vena cava obstruction. Chest 1993; 103: 394S-397S
  • 8 Capek P, Cope C. Percutaneous treatment of superior vena cava syndrome. AJR Am J Roentgenol 1989; 152: 183-184
  • 9 Kee ST, Kinoshita L, Razavi MK et al. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement. Radiology 1998; 206: 187-193
  • 10 Gross CM, Krämer J, Waigand J et al. Stent implantation in patients with superior vena cava syndrome. AJR Am J Roentgenol 1997; 169: 429-432
  • 11 Chin DH, Petersen BD, Timmermans H et al. Stent-graft in the management of superior vena cava syndrome. Cardiovasc Intervent Radiol 1996; 19: 302-304
  • 12 Mathias K, Jäger H, Willaschek J et al. [Interventional radiology in central venous obstructions. Dilatation -- stent implantation -- thrombolysis]. Radiologe 1998; 38: 606-613
  • 13 Miller JH, McBride K, Little F et al. Malignant superior vena cava obstruction: stent placement via the subclavian route. Cardiovasc Intervent Radiol 2000; 23: 155-158
  • 14 Dyet JF, Nicholson AA, Cook AM. The use of the Wallstent endovascular prosthesis in the treatment of malignant obstruction of the superior vena cava. Clinical Radiology 1993; 48: 381-385
  • 15 Stock KW, Jacob AL, Proske M et al. Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent. Thorax 1995; 50: 1151-1156
  • 16 Teo N, Sabharwal T, Rowland E et al. Treatment of superior vena cava obstruction secondary to pacemaker wires with balloon venoplasty and insertion of metallic stents. Eur. Heart J 2002; 23: 1465-1470
  • 17 Melikian N, Brookes CI, Rickards AF. Management of superior vena caval obstruction secondary to a pacing wire with percutaneous intravascular stent insertion. Heart 1999; 82: 182
  • 18 Goldstraw P, Crowley J, Chansky K et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2: 706-714
  • 19 Shepherd FA, Crowley J, Van Houtte P et al. The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer. J Thorac Oncol 2007; 2: 1067-1077
  • 20 Hennequin LM, Fade O, Fays JG et al. Superior vena cava stent placement: results with the Wallstent endoprosthesis. Radiology 1995; 196: 353-361
  • 21 Watkinson AF, Hansell DM. Expandable Wallstent for the treatment of obstruction of the superior vena cava. Thorax 1993; 48: 915-920
  • 22 Dodds GA, Harrison JK, O'Laughlin MP et al. Relief of superior vena cava syndrome due to fibrosing mediastinitis using the Palmaz stent. Chest 1994; 106: 315-318
  • 23 Rösch J, Uchida BT, Hall LD et al. Gianturco-Rösch expandable Z-stents in the treatment of superior vena cava syndrome. Cardiovasc Intervent Radiol 1992; 15: 319-327