Interventional Therapy For Stenosis And Occlusion In Superior Vena Cava And Its Major Tributaries

Objective: The superior vena cava and its major tributaries (brachiocephalic vein, subclavian vein, internal jugular vein and external jugular vein) can be caused by a variety of reasons cavity stenosis or occlusion, leading to venous reflux barrier and a corresponding clinical symptoms .At present, the treatment of such diseases include: medical conservative treatment, radiotherapy, chemotherapy, surgical treatment and interventional therapy. For such disease, Conservative medical treatment is not obvious, the radiotherapy and chemotherapy onset slowly, and surgical indications limit, and there is greater risk. With the development of interventional radiology, vascular angioplasty and or stenting of its minimally invasive advantages become the preferred method of treatment of such diseases, but also obtain a satisfactory clinical effects. This study case analysis to explore the superior vena cava and its major branches of stenosis or occlusion of the interventional therapy, analysis of treatment and evaluation of interventional treatment of disease in this type of application.Method: Chose from a variety of reasons for the superior vena cava and its tributaries in patients with stenosis or occlusion of 30 cases, male 18 cases, female 12 cases. Aged 15-72 years (mean 58 years). In which the superior vena cava obstruction in 20 cases, brachiocephalic vein obstruction in 4 cases, axillary - subclavian vein venous obstruction in 4 cases, internal jugular vein obstruction in 2 cases. Causes include: central venous catheters in 4 cases, 3 cases of clavicular fracture, blood hypercoagulability in 3 cases, malignant superior vena cava syndrome caused by compression of 20 cases.Patients underwent preoperative chest enhanced CT and color Doppler ultrasound examination to determine the lesion location, nature and extent of endovascular obstruction location, length and severity of the choice of interventional treatment to provide the basis of anatomy and imaging. Laboratory tests have been improved, and the agreements have been signed. This group of patients underwent full preoperative preparation before interventional therapy. 30 patients of this group caused by the superior vena cava and its major branches of stenosis or occlusion have all been given interventional therapy through multi-channel approachs. 8 cases of patients in 30 who meet the filter insertion have been given the superior vena cava filter. All this patients were treated with catheter thrombolysis, endovascular balloon dilatation or stent implantation. For the patients with brachiocephalic vein, axillary-subclavian vein and jugular vein stenosis or occlusion, while superior vena cava smooth, we first intubated through the femoral vein, and try to guide wire, catheter through the narrow occluded segment. Then observed the site of obstruction, stenosis, extent, the formation of collateral circulation, and whether or thrombosis by imaging. If did not find intravascular filling defect, then you could give balloon expansion, stent implantation directly. Contrast If you find filling defect, then it prompts the prompt thrombosis. First place the filter in the superior vena cava. Later in the guide of wire-guided, the thrombolysis catheter was put directly into the thrombus, with urokinase dosage of 50-100wu, injection speed 50wu / h. For the large amount of thrombus in patients ,the catheters should be retained and sustained thrombolysis. For after thrombolysis, stenosis or occlusion, then diverted through the brachial vein or internal jugular vein approach, balloon dilatation and stent implantation. For the superior vena cava stenosis or occlusion in patients with the same first through the femoral vein catheterization, managed to guide wire, catheter through the stenosis or occlusion segment angiography stenosis occlusion of the extent, scope and availability of thrombosis. If it had thrombosis, thrombolytic therapy first, and then opened the narrow. The balloon used from small to large.Blood vessels before and after opening, respectively, of vascular obstruction in the distal intravascular pressure measurements. And its obstruction of distal cavity pressure measurement value is divided into rows angioplasty before treatment group (before treatment group) and the line of angioplasty treatment group (treated group), after statistical software SPSS17.0 treatment, obtained P <0.05 to illustrate before and after angioplasty, obstructive changes of the distal venous pressure difference statistically significant.Results: 30 patients after angioplasty, obstruction distal venous pressure values measured from the open front of 25.4±2.8mmHg, decreased after 7.3±1.2mmHg, through the homogeneity of variance and normality tests available to the group of data does not meet the normal distribution, variance missing, and the number of cases less. Therefore, compared with the paired samples Wilcoxon signed-rank test, after a statistical software SPSS processing line before and after angioplasty, obstructive changes of the distal venous pressure was significantly (P<0.05), can be considered angioplasty and stent implantation is an effective way to treat the disease. Accepted 24 ~ 72h after interventional therapy within the clinical symptoms have been alleviated. 30 patients during and after surgery were not chest tightness, shortness of breath and other pulmonary complications, oxygen saturation were above 95%. 72h face, neck, shoulder or upper extremity swelling and relieve skin tension decreased, dizziness, headache symptoms improved, response rate 100%. 2 weeks after the review enhanced CT, all patients the blood vessels open the stent were not built into the shift occurred.