Endovascular stent provides more effective early relief of SVC obstruction compared to balloon angioplasty

Authors

  • Osamah Aldoss MD,

    1. Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
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  • Nofil Arain MD,

    1. Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
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  • Jeremiah Menk MS,

    1. Department of Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota
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  • Lazaros Kochilas MD,

    1. Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
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  • Daniel Gruenstein MD

    Corresponding author
    1. Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
    • Correspondence to: Daniel Gruenstein, MD, Pediatric Cardiology, East Building, 5th Floor, Room MB 551, 2450 Riverside Avenue, Minneapolis, MN 55454. E-mail: gruen040@umn.edu

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  • Conflict of interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Abstract

Objective

To determine whether superior vena cava (SVC) stent implantation is superior to balloon angioplasty for relieving SVC stenosis.

Background

SVC stent and balloon dilation have been used as treatment for SVC stenosis. Although safe and effective, outcome data comparing the two methods are limited.

Methods

A Pediatric Cardiac Care Consortium review identified SVC stenosis. Patients who required SVC intervention were divided into two subgroups—balloon dilation (Group A) and stent implantation (Group B). Logistic regression and the log-rank test were used to test the need for re-intervention within 6 months after the initial procedure.

Results

SVC intervention was performed on 210/637 patients with SVC stenosis (33%). There were 108/210 (51%) patients with balloon dilation (Group A) and 102/210 (49%) with stent implantation (Group B). Re-intervention within 6 months of the initial intervention was more common in Group A compared to Group B [Group A = 31/40 (77.5%); Group B = 5/22 (22.7%)]. The odds-ratio for re-intervention within 6 months of the initial procedure for balloon vs. stent, is 7.3 [95% CI: (2.91, 22.3), P < 0.0001]. In addition, during the first 6 months after an intervention for SVC stenosis the proportion of patients with stent implantation that remained free of re-intervention was significantly higher than after balloon angioplasty (log-rank test, P < 0.0001). Neither age nor weight was significantly associated with the need for re-intervention.

Conclusions

SVC stent implantation is more effective than angioplasty in relief of SVC obstruction. Weight and age are not risk factors for early re-intervention. © 2012 Wiley Periodicals, Inc.

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