Κατεύθυνση Επεμβατική Ακτινολογία
Library of the School of Health Sciences

2017-08-29

2017

Iphantis Nikolaos

Μαλαγάρη Αικατερίνη,Αναπληρώτρια Καθηγήτρια Ακτινολογίας,Ιατρική Σχολή,ΕΚΠΑ
Αλεξοπούλου Ευθυμία,Αναπληρώτρια Καθηγήτρια Ακτινολογίας,Ιατρική Σχολή,ΕΚΠΑ
Κελέκης Αλέξιος,Αναπληρωτής Καθηγητής Επεμβατικής Ακτινολογίας,Ιατρική Σχολή,ΕΚΠΑ

Χρήση ενδαγγειακής ενδοπρόθεσης (stent) στην αντιμετώπιση συνδρόμου άνω κοίλης φλέβας νεοπλασματικής αιτιολογίας

Greek

Stent as treatment option in malignant superior vena cava syndrome

Superior vena cava (SVC) syndrome results from obstruction of blood flow in the SVC. The majority of cases are due to malignancy, and approximately 95 percent of these are due to lung cancer or non-Hodgkin lymphoma (NHL). Malignancy-related SVC syndrome was previously considered a potentially life-threatening medical emergency requiring immediate radiation therapy to rapidly relieve the obstruction. Emergency RT is no longer considered necessary for most patients. Current management guidelines stress the importance of accurate histologic diagnosis prior to starting therapy, and the upfront use of endovascular stents in severely symptomatic patients to provide more rapid symptom relief than can be achieved using RT. Stent effectiveness ranged from 81% to 100% and is unrelated to stent type. Reobstruction rates ranged from 0% to 33%.Important exceptions to this general approach are patients who present with stridor due to central airway obstruction or severe laryngeal edema causing respiratory compromise, and those with depressed central nervous system status from cerebral edema. These situations represent true medical emergencies, and these patients require both endovascular stenting and emergent RT to decrease the risk of sudden respiratory failure and death.Initial management should be guided by the severity of symptoms and the underlying malignant condition as well as the anticipated response to treatment. A system for grading the severity of SVC syndrome and a treatment algorithm based upon the symptom severity and the underlying malignancy have been proposed by clinicians at Yale University. Interventions should be guided by the objective of not constraining or delaying biopsy. In patients with malignancy, after stenting, concurrent radiation therapy with chemotherapy is advised to optimize outcome and prevent tumor growth near the stent. In patients who have been treated for a malignant cause of SVCS and who suffer from a relapse, endovascular stenting might be a suitable option. For most treatment options that aim to directly treat the signs and symptoms of SVCS, randomized controlled trials are still lacking.

Health Sciences

Superior vena cava syndrome, Stent, Malignancy, Efficacy, Comparison

No

0

Yes

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https://pergamos.lib.uoa.gr/uoa/dl/object/1838102