Wallstent for SVC Syndrome

COMMENTS?

 

 

Case Demonstration:
There is a large superior mediastinal mass caused by lung cancer 

Chest Xray before stenting Lung CA with Large superior mediastinal mass causing obstruction of the SVC and swelling of the face.

Chest Xray after stenting Wallstent in place restoring flow to SVC facial swelling symptoms resolved imediately

 
First, a Diagnostic Venogram was performed by injecting iodinated contrast into the right antecubital vein in the arm and observing with the flouroscope the venous return to the SVC.

Here are the images of the venogram showing SVC obstruction:

Right axillary vein opacified and looks good

Obstructed svc with collaterals

Portacath is still in place though

 
Wallstent placement into SVC was performed through a vascular sheath placed through the right antecubital vein to the SVC . Once the stent is in place in the SVC, an angioplasty balloon catheter is advanced into the stent and inflated with iodinated contrast to expand the stent and restore flow in the lumen of the vessel.

A final venogram is then done to document flow in the SVC through the previously obstructed segment:

balloon inflated to open stent

venogram with stent in place

showing good flow into svc

 
Immediately after stent placement, the patient noticed immediate resolution of the facial swelling and puffy eyelids typical of the SVC obstruction Syndrome. Please note that this procedure is palliative only and is designed to provide symptomatic relief from SVC obstruction. It does not address the underlying malignant tumor which will unfortunately continue to grow.

This case was done by Jeffrey Dach, M.D. Interventional Radiologist at Pembroke Memorial Hospital.