Literature Review of Percutaneous Stenting for Palliative Treatment of Malignant Superior Vena Cava Syndrome (SVCS)

Rationale and Objectives: To assess the efficacy and safety of percutaneous stenting for the palliative treatment of malignant superior vena cava syndrome (SVCS). Methods and Materials: Literature review of retrospective studies was performed regarding direct procedural complications (fatal and non-fatal), clinical effectiveness, and patency rates (primary and secondary) of percutaneous transluminal stenting for the palliative treatment of malignant SVCS. Pooled rates and 95% confidence intervals were calculated for fatal complications, non-fatal complications, clinical effectiveness, primary patency, and secondary patency. Pooled rates were presented overall and by stent types (Wallstent, Nitinol stents, Steel stents and Stent Graft). Odds ratios and 95% confidence intervals were calculated to compare rates by stent type. Results: Overall fatal complications rate was 1.46%, 95% CI [0.91 –2.23], non-fatal complications rate was 8.28%, 95% CI [6.91 –9.83], clinical effectiveness was 90.50%, 95% CI [88.86 –91.97], primary patency rate was 86.18%, 95% CI [84.06-88.12], secondary patency rate was 94.05 %, 95% CI [91.82 –95.82]. Primary patency rate of the Wallstent group was 83.38%, 95% CI [79.34 –86.90], and significantly higher for the Nitinol group 94.87%, 95% CI [87.40 –98.60], OR = 3.67, p = 0.01, and for the Stent Graft group 96.10%, 95% CI [89.00 –99.20], OR = 4.92, p = 0.01. Secondary patency rate for the Wallstent group was 93.33%, 95% CI [88.87 –96.40] and significantly lower for the Steel group 77.42%, 95% CI [58.90 –90.41], OR = 0.25, p = 0.01. Conclusion: Percutaneous stenting is a safe option for palliative treatment of patients with malignant SVCS with greater than 90% of patients experiencing immediate relief of symptoms, low rates of fatal complications (1.46%) and high patency rates (86.18% primary patency and 94.05% secondary patency).