Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000400011
Jornal Vascular Brasileiro
Case Report

Tratamento endovascular da síndrome da veia cava superior: relato de caso e revisão da literatura

Endovascular treatment of superior vena cava syndrome: case report and review of the literature

Marco Aurélio Cardozo; Eduardo Lichtenfels; Nilon Erling Jr.; Dorvaldo P. Tarasconi

http://dx.doi.org/10.1590/S1677-54492006000400011 J Vasc Bras, vol.5, n4, p.308-312, 2006
PDF
Downloads: 2
Views: 1675

Resumo

Relatamos o caso de uma paciente portadora de síndrome da veia cava superior sintomática de origem benigna tratada pela técnica endovascular. A angiorressonância magnética pré-angioplastia evidenciou extensa trombose do tronco braquiocefálico esquerdo, da veia subclávia esquerda e obstrução da veia cava superior junto ao tronco braquiocefálico direito. A paciente realizou mastectomia radical 2 anos antes, associada à quimioterapia e radioterapia do tórax. Foram realizados angioplastia venosa e implante de stent expansível por balão. O resultado foi satisfatório, com alívio imediato dos sintomas devido à recanalização da veia cava superior e do tronco braquiocefálico direito. Foi instituída anticoagulação oral. A paciente permanece sem recidiva dos sintomas após 8 meses de acompanhamento. O tratamento endovascular é uma alternativa terapêutica com baixa morbidade e resultado satisfatório a médio prazo que pode ser oferecida aos pacientes portadores de síndrome da veia cava superior.

Palavras-chave

Angioplastia, veia cava, estenose

Abstract

We report a case of a patient with symptomatic benign superior vena cava syndrome treated by the endovascular technique. The angiographic resonance before angioplasty showed extensive thrombosis of the left brachiocephalic trunk, left subclavian vein and superior vena cava obstruction close to the right brachiocephalic trunk. The patient underwent radical mastectomy 2 years ago with adjuvant chemotherapy and chest radiotherapy. Venous angioplasty and balloon-expandable stenting were performed. Satisfactory result was obtained with immediate relief of symptoms due to recanalization of the right brachiocephalic trunk and superior vena cava. Oral anticoagulation was initiated. The patient is still asymptomatic after 8 months of follow-up. The endovascular treatment is a therapeutic alternative with low morbidity and satisfactory mid-term results that can be offered to patients with superior vena cava syndrome.

Keywords

Angioplasty, vena cava, stenosis

References

Gray RJ, Dolmatch BL, Horton KM, Romolo JL, Zarate AR. Migration of Palmaz stents following deployment for venous stenoses related hemodialysis access. J Vasc Interv Radiol.. 1994;5:117-20.

Parish JM, Marschke RF Jr., Dines DE, RE Lee. Etiologic considerations in superior vena cava syndrome. Mayo Clin Proc.. 1981;56:407-13.

Nieto AF, Doty DB. Superior vena cava obstruction: clinical syndrome, etiology and treatment. Curr Probl Cancer.. 1986;10:441-84.

Perez-Soler R, McLaughlin P, Velasquez WS. Clinical features and results of management of superior vena cava syndrome secondary to lymphoma. J Clin Oncol.. 1984;2:260-6.

Gloviczki P, Vrtiska TJ. Surgical treatment of superior vena cava syndrome. Vascular surgery. 2000:2093-104.

Chen JC, Bongard F, Klein SR. A contemporary perspective on superior vena cava syndrome. Am J Surg.. 1990;160:207-11.

Van Putten JW, Schlosser NJ, Vujaskovic Z, Leest AH, Groen HJ. Superior vena cava obstruction caused by radiation induced venous fibrosis. Thorax.. 2000;55:245-6.

Kalra M, Gloviczki P, Andrews JC. Open surgical and endovascular treatment of superior vena cava syndrome caused by nonmalignant disease. J Vasc Surg.. 2003;38:215-23.

Cordeiro SZB, Cordeiro PB. Síndrome de veia cava superior. J Pneumol.. 2002;28:288-93.

Cirino LMI, Coelho RF, Rocha ID, Batista BPSN. Tratamento da síndrome da veia cava superior. J Bras Pneumol.. 2005;31:540-50.

Liddel RP, Dake MD. Endovascular treatment of chronic occlusions of large veins. Vascular surgery. 2000:2066-76.

Hennequin LM, Fade O, Fays JG. Superior vena cava stent placement: results with the Wallstent endoprosthesis. Radiology. 1995;196:353-61.

Sunder SK, Ekong EA, Sivalingam K, Kumar A. Superior vena cava thrombosis due to pacing electrodes: successful treatment with combined thrombolysis and angioplasty. Am Heart J.. 1992;123:790-2.

Dartevelle PG, Chapelier AR, Pastorino U. Long-term follow-up after prosthetic replacement of the superior vena cava combined with resection of mediastinal-pulmonary malignant tumors. J Thorac Cardiovasc Surg.. 1991;102:259-65.

Yim CD, Sane SS, Bjarnason H. Superior vena cava stenting. Radiol Clin North Am.. 2000;38:409-24.

Bornak A, Wicky S, Ris HB, Probst H, Milesi I, Corpataux JM. Endovascular treatment of stenoses in the superior vena cava syndrome caused by non-tumoral lesions. Eur Radiol.. 2003;13:950-6.

Smayra T, Otal P, Chabbert V. Long-term results of endovascular stent placement in the superior caval venous system. Cardiovasc Intervent Radiol.. 2001;24:388-94.

Kee ST, Kinoshita L, Razavi MK, Nyman UR, Semba CP, Dake MD. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement. Radiology. 1998;206:187-93.

Haage P, Vorwerk D, Piroth W, Schuermann K, Guenther RW. Treatment of hemodialysis-related central venous stenosis or occlusion: results of primary Wallstent placement and follow-up in 50 patients. Radiology. 1999;212:175-80.

Jackson JE, Brooks DM. Stenting of superior vena cava obstruction. Thorax. 1995;50:S31-6.

Alimi YS, Gloviczki P, Vrtiska TJ. Reconstruction of superior vena cava: benefits of postoperative surveillance and secondary endovascular interventions. J Vasc Surg.. 1998;27:300-1.

Furui S, Sawada S, Kuramoto K. Gianturco stent placement in malignant caval obstruction: analysis of factors for predicting the outcome. Radiology. 1995;195:147-52.

Oudkerk M, Kuijpers TJ, Schmitz PI, Loosveld O, de Wit R. Self-expanding metal stents for palliative treatment of superior vena caval syndrome. Cardiovasc Intervent Radiol.. 1996;19:146-51.

Rosch J, Bedell JE, Putnam J, Antonovic R, Uchida B. Gianturco expandable wire stents in the treatment of superior vena cava syndrome recurring after maximum-tolerance radiation. Cancer. 1987;60:1243-6.

Shah R, Sabanathan S, Lowe RA, Mearns AJ. Stenting in malignant obstruction of superior vena cava. J Thorac Cardiovasc Surg.. 1996;112:335-40.

Crowe MT, Davies CH, Gaines PA. Percutaneous management of superior vena cava occlusions. Cardiovasc Intervent Radiol.. 1995;18:367-72.

Zollikofer CL. Stent treatment in the venous circulation. Radiology of peripheral vascular diseases. 2000:669-77.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5de95c7c0e8825b06ce31d41 jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections