Supportive Care in Cancer

, Volume 26, Issue 6, pp 1881–1888 | Cite as

Endovascular stent-based revascularization of malignant superior vena cava syndrome with concomitant implantation of a port device using a dual venous approach

  • Susanne AntonEmail author
  • T. Oechtering
  • E. Stahlberg
  • F. Jacob
  • M. Kleemann
  • J. Barkhausen
  • J. P. Goltz
Original Article



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.

Materials and methods

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 XL®, OptiMed, Germany; n = 11 [Group1] and Protégé ™ 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.


Malignant superior vena cava syndrome Endovascular Stent Totally implantable venous access Dual venous approach 


Compliance with ethical standards

Local ethical committee approval was granted (File number 17-044A). This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Hamzika J, Chudejb J, Dziana A, Sokolb J, Kubisz P (2015) Endovascular stenting in malignant obstruction of superior vena cava. Int J Surg Case Rep 13:84–87. CrossRefGoogle Scholar
  2. 2.
    Rice TW, Rodriguez RM, Light RW (2006) The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine 85(1):37–42. CrossRefPubMedGoogle Scholar
  3. 3.
    Schraufnagel DE, Hill R, Leech JA, Pare JA (1981) Superior vena caval obstruction. Is it a medical emergency? Am J Med 70(6):1169–1174. CrossRefPubMedGoogle Scholar
  4. 4.
    Duvnjak S, Andersen PE (2011) Endovascular treatment of superior vena cava syndrome. Int Angiol 30(5):458–461PubMedGoogle Scholar
  5. 5.
    Lanciego L, Pangua C, Chacon JI et al (2009) Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome. Am J Roentgenol 193(2):549–558. CrossRefGoogle Scholar
  6. 6.
    Fagedet D, Thony F, Timsit JF, Rodiere M, Monnin-Bares V, Ferretti GR, Vesin A, Moro-Sibilot D (2013) Endovascular treatment of malignant superior vena cava syndrome: results and predictive factors of clinical efficacy. Cardiovasc Intervent Radiol 36(1):140–149. CrossRefPubMedGoogle Scholar
  7. 7.
    Urruticoechea A, Mesia R, Dominguez J et al (2004) Treatment of malignant superior vena cava syndrome by endovascular stent insertion. Experience on 52 patients with lung cancer. Lung Cancer 43(2):209–214. CrossRefPubMedGoogle Scholar
  8. 8.
    Rowell NP, Gleeson FV (2002) Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. Clin Oncol 14(5):338–351. CrossRefGoogle Scholar
  9. 9.
    Krombach GA, Plumhans C, Goerg F, Günther RW (2010) Central vein dilatation prior to concomitant port implantation. Cardiovasc Intervent Radiol 33(2):362–366. CrossRefPubMedGoogle Scholar
  10. 10.
    Büstgens FA, Loose R, Ficker JH, Wucherer M, Uder M, Adamus M (2017) Stent implantation for superior vena cava syndrome of malignant cause. Fortschr Röntgenstr 189:423–430CrossRefGoogle Scholar
  11. 11.
    Lanciego C, Chacon JL, Julian A et al (2001) Stenting as first option for endovascular treatment of malignant superior vena cava syndrome. Am J Roentgenol 177(3):585–593. CrossRefGoogle Scholar
  12. 12.
    Dinkel HP, Mettke B, Schmid F, Baumgartner I, Triller J, Do DD (2003) Endovascular treatment of malignant superior vena cava syndrome: is bilateral wallstent placement superior to unilateral placement? J Endovasc Ther 10(4):788–797. CrossRefPubMedGoogle Scholar
  13. 13.
    Mokry T, Bellemann N, Sommer CM, Heussel CP, Bozorgmehr F, Gnutzmann D, Kortes NA, Kauczor HU, Radeleff B, Stampfl U (2015) Retrospective study in 23 patients of the self-expanding sinus-XL stent for treatment of malignant superior vena cava obstruction caused by non-small cell lung cancer. J Vasc Interv Radiol 26(3):357–365. CrossRefPubMedGoogle Scholar
  14. 14.
    Sacks D, Marinelli DL, Martin LG et al (2003) Reporting standards for clinical evaluation of new peripheral arterial revascularization devices. J Vasc Interv Radiol 14:395–404CrossRefGoogle Scholar
  15. 15.
    Stanford W, Jolles H, Stephen E, Chiu LC (1987) Superior vena cava obstruction: a venographic classification. AJR 148(2):259–262. CrossRefPubMedGoogle Scholar
  16. 16.
    Hamzik J, Chudej J, Dzian A, Sokol J, Kubisz P (2015) Endovascular stenting in malignant obstruction of superior vena cava. Int J Surg Case Rep 13:84–87. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Uberoi R, Patel R, Cox P et al (2015) CIRSE Quality assurance guidelines for superior vena cava stenting in malignant disease. Accessed 28 May 2017
  18. 18.
    Duvnjak S (2011) Malignant superior vena cava syndrome: endovascular stent treatment current status. J Palliat Care Med 1:1Google Scholar
  19. 19.
    Ganeshan A, Hon LQ, Warakaulle DR, Morgan R, Uberoi R (2009) Superior vena caval stenting for SVC obstruction: current status. Eur J Radiol 71(2):343–349. CrossRefPubMedGoogle Scholar
  20. 20.
    Sobrinho G, Aguiar P (2014) Stent placement for the treatment of malignant superior vena cava syndrome—a single-center series of 56 patients. Arch Bronconeumol 50(4):135–140. CrossRefPubMedGoogle Scholar
  21. 21.
    De Gregorio Ariza MA, Gamboa P, Gimeno MJ et al (2003) Percutaneous treatment of superior vena cava syndrome using metallic stent. Eur Radiol 13(4):853–862. CrossRefPubMedGoogle Scholar
  22. 22.
    Rizvi AZ, Kalra M, Bjarnason H, Bower TC, Schleck C, Gloviczki P (2008) Benign superior vena cava syndrome: stenting is now the first line of treatment. J Vasc Surg 47(2):372–380. CrossRefPubMedGoogle Scholar
  23. 23.
    Breault S, Doenz F, Jouannic AM, Qanadli SD (2017) Percutaneous endovascular management of chronic superior vena cava syndrome of benign causes: long-term follow-up. Eur Radiol 27(1):97–104. CrossRefPubMedGoogle Scholar
  24. 24.
    Trerotola SO, Kuhn-Fulton J, Johnson MS, Shah H, Ambrosius WT, Kneebone PH (2000) Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access. Radiology 217(1):89–93. CrossRefPubMedGoogle Scholar
  25. 25.
    Takeuchi Y, Arai Y, Kasahara T, Inaba Y, Shindo J, Kumada T (2000) Technical aspects of venous stenting in high-grade stenoses using a long guidewire between dual venous access sites. Eur Radiol 10(1):167–169. CrossRefPubMedGoogle Scholar
  26. 26.
    Tonak J, Fetscher S, Barkhausen J, Goltz JP (2015) Endovascular recanalization of a port catheter-associated superior vena cava syndrome. J Vasc Access 16(5):434–436. CrossRefPubMedGoogle Scholar
  27. 27.
    Thony F, Fagedet D, Michoud M, Moro-Sibilot D, Ferretti GR, Rodière M (2014) Anticoagulation is not mandatory after stenting for malignant superior vena cava syndrome. Cardiovasc Intervent Radiol 37(5):1403–1404. CrossRefPubMedGoogle Scholar
  28. 28.
    Steinberger JD, Schenning RC (2015) Endovascular reconstruction of malignant IVC and SVC obstruction. IO:111–113Google Scholar
  29. 29.
    Nagata T, Makutani S, Uchida H, Kichikawa K, Maeda M, Yoshioka T, Anai H, Sakaguchi H, Yoshimura H (2007) Follow-up results of 71 patients undergoing metallic stent placement for the treatment of a malignant obstruction of the superior vena cava. Cardiovasc Intervent Radiol 30(5):959–967. CrossRefPubMedGoogle Scholar
  30. 30.
    Maleux G, Gillardin P, Fieuws S, Heye S, Vaninbroukx J, Nackaerts K (2013) Large-bore nitinol stents for malignant superior vena cava syndrome: factors influencing outcome. AJR Am J Roentgenol 201(3):667–674. CrossRefPubMedGoogle Scholar
  31. 31.
    Quaretti P, Galli F, Moramarco LP, Corti R, Leati G, Fiorina I, Tinelli C, Montagna G, Maestri M (2016) Stent grafts provided superior primary patency for central venous stenosis treatment in comparison with angioplasty and bare metal stent: a retrospective single center study on 70 hemodialysis patients. Vasc Endovasc Surg 50(4):221–230. CrossRefGoogle Scholar
  32. 32.
    Gwon DI, Ko GY, Kim JH, Shin JH, Yoon HK, Sung KB (2013) Malignant superior vena cava syndrome: a comparative cohort study of treatment with covered stents versus uncovered stents. Radiology 266(3):979–987. CrossRefPubMedGoogle Scholar
  33. 33.
    Clark K, Beecham Chick JF, Reddy SN et al (2017) Concurrent central venous stent and central venous access device placement does not compromise stent patency or catheter function in patients with malignant central venous obstruction. J Vasc Interv Radiol 28(4):602–607. CrossRefPubMedGoogle Scholar
  34. 34.
    El-Sabrout RA, Duncan JM (1999) Right atrial bypass grafting for central venous obstruction associated with dialysis access: another treatment option. J Vasc Surg 29(3):472–478. CrossRefPubMedGoogle Scholar
  35. 35.
    Tanigawa N, Sawada S, Mishima K, Okuda Y, Mizukawa K, Ohmura N, Toita T, Ogawa K, Kobayashi M, Kobayashi M (1998) Clinical outcome of stenting in superior vena cava syndrome associated with malignant tumours. Comparison with conventional treatment. Acta Radiol 39(6):669–674. CrossRefPubMedGoogle Scholar
  36. 36.
    Nguyen N, Borok TL, Welsh J, Vinh-Hung V (2009) Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome. Thorax 64(2):174–178. CrossRefPubMedGoogle Scholar
  37. 37.
    Thony F, Moro D, Witmeyer P, Angiolini S, Brambilla C, Coulomb M, Ferretti G (1999) Endovascular treatment of superior vena cava obstruction in patients with malignancies. Eur Radiol 9(5):965–971. CrossRefPubMedGoogle Scholar
  38. 38.
    Wu CY, Fu JY, Feng PH et al (2012) Risk factors and possible mechanisms of intravenous port catheter migration. Eur J Vasc Endovasc Surg 44:82–87CrossRefGoogle Scholar
  39. 39.
    Walser EM (2012) Venous access ports: indications, implantation technique, follow-up, and complications. Cardiovasc Intervent Radiol 35(4):751–764. CrossRefPubMedGoogle Scholar
  40. 40.
    Andersen PE, Midtgaard A, Brenoe AS, Elle B, Duvnjak S (2015) A new nitinol stent for use in superior cava syndrome. Initial clinical experience. J Cardiovasc Surg 56:877–881Google Scholar
  41. 41.
    Ploegmakers MJ, Rutten MJ (2009) Fatal pericardial tamponade after superior vena cava stenting. Cardiovasc Intervent Radiol 32(3):585–589. CrossRefPubMedGoogle Scholar
  42. 42.
    Uberoi R (2006) Quality assurance guidelines for superior vena cava stenting in malignant disease. Cardiovasc Intervent Radiol 29(3):319–322. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Clinic for Radiology and Nuclear MedicineUniversity Hospital of Schleswig-Holstein, Campus LübeckLübeckGermany
  2. 2.Clinic for SurgeryUniversity Hospital of Schleswig-Holstein, Campus LübeckLübeckGermany

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