Algorithm for percutaneous stenting in patients suffering from superior vena cava syndrome = [Algoritem zdravljenja sindroma zgornje vene cave s perkutanim stentom]
Vodvářka, Pavel ; Štverák, Petr
Background. Superior vena cava syndrome (SVCS) has been considered an emergent, life-threatening condition for a long time. The rate of causes of the syndrome has changed substantially since its ...first description by W. Hunter in a patient suffering from saccular aneurysm of syphilitic aorta in 1757. Since the beginning of the era of radiotherapy, this was the main treatment modality for patients with SVCS. The emergent feature of the syndrome required immediate initiation of radiotherapy, often without the proper knowledge of the histopathological diagnosis of the SVCS underlying cause. The development of radiotherapy and chemotherapy in various types of cancer, and the development of supportive care in oncology and an understanding that SVCS is not an emergent life-threatening oncological condition evoked a need for treatment differentiation in SVCS patients. Conclusions. Percutaneous stenting become a very efficient method in the treatment of SVCS patients since 1986. The purpose of stenting is supportive and/or palliative. The algorithm for stenting use has been developed. Algorithm is based on 4 questions emerging from daily clinical practice. To get valid responses, certain diagnostic procedures and tools are recommended and required. 1. Does the patient really suffer from SVCS? 2. What is the patients general condition? 3. Is the stenting of SVCS contraindicated? (What is the origin of SVCS, what is the severity of SVCS?) 4. Is the histopathologyof the process causing SVCS known? What is the histopathology ofthe process causing SVCS? Responses to the questions above give reasons for the selection of a treatment modality. Ration usage of percutaneous implantable stents in properly chosen patients suffering from SVCS of malignant ethiology ensures efficient differentiation of treatment modalities in supportive and/or palliative care of SVCS patients.
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