superior vena cava syndrome treatment risks

[Cece]

In a post that has gone missing (modded, perhaps, or gh0sted?), Malden was interested in comparing the risks of superior vena cava syndrome treatment with the risks of CCSVI treatment. I did a quick search, this came up:

•In a 1988 report, Adelstein et al discuss prophylaxis against embolic events in the presence of a superior vena cava (SVC) obstruction in the management of 25 patients with malignant superior vena cava syndrome (SVCS).29 •Ten patients were retrospectively reviewed after having been diagnosed clinically without venography and treated without anticoagulation. Five thromboembolic complications occurred, 2 of which proved fatal.•Fifteen patients were prospectively evaluated by means of angiography and then treated with anticoagulants. Angiographic evidence of intraluminal subclavian vein or superior vena cava (SVC) thrombosis was found in 5 of these patients, and no thromboembolic complications occurred.
•Of the 20 patients who were ultimately given anticoagulation therapy, 2 had fatal intracranial hemorrhages.•The authors suggested the need for randomized prospective trials if the role of venography and anticoagulation in this syndrome is to be determined.29

http://emedicine.medscape.com/article/460865-treatment
This was malignant SVCS, this was probably more extensive anticoagulation than what we're given, but to me it underlies that anticoagulation needs to be chosen with care and that one of the many big things our docs need to do is to determine what's best in this regard.

[scorpion]

In a post that has gone missing (modded, perhaps, or gh0sted?), Malden was interested in comparing the risks of superior vena cava syndrome treatment with the risks of CCSVI treatment. I did a quick search, this came up:

•In a 1988 report, Adelstein et al discuss prophylaxis against embolic events in the presence of a superior vena cava (SVC) obstruction in the management of 25 patients with malignant superior vena cava syndrome (SVCS).29 •Ten patients were retrospectively reviewed after having been diagnosed clinically without venography and treated without anticoagulation. Five thromboembolic complications occurred, 2 of which proved fatal.•Fifteen patients were prospectively evaluated by means of angiography and then treated with anticoagulants. Angiographic evidence of intraluminal subclavian vein or superior vena cava (SVC) thrombosis was found in 5 of these patients, and no thromboembolic complications occurred.
•Of the 20 patients who were ultimately given anticoagulation therapy, 2 had fatal intracranial hemorrhages.•The authors suggested the need for randomized prospective trials if the role of venography and anticoagulation in this syndrome is to be determined.29

http://emedicine.medscape.com/article/460865-treatment
This was malignant SVCS, this was probably more extensive anticoagulation than what we're given, but to me it underlies that anticoagulation needs to be chosen with care and that one of the many big things our docs need to do is to determine what's best in this regard.

ghosted.....

[cheerleader]

Here's a more recent study, Cece---from 2005, in patients w/out malignancy. More comparable to CCSVI.

http://www.hemodinamiadelsur.com.ar/jou ... al_078.asp

The overall durability and longevity of the endovascular procedure is a concern in patients with benign disease and a normal life expectancy. Long-term success was achieved in the majority of patients with nonmalignant SVC syndrome. Rosenblum et al. [[4]] found no recurrent thromboses or stenoses in four patients followed 5-24 months. One of 12 patients followed 1-36 months required repeat intervention for benign SVC obstruction [[3]]. Bornak et al. [[7]] reported a 67% patency at 12 months. Two patients had recurrent symptoms and were treated with repeat intervention with satisfactory results. Kee et al. [[2]] followed 10 patients for a mean of 17 months without recurrent symptoms. One patient required multiple repeat interventions to maintain patency. These reports suggest that results of endovascular treatment of nonmalignant SVC obstruction are satisfactory at 1-2 years. Our results also support this contention. Our documented follow-up of more than 6 years in three patients is the longest we identified in the literature. This seems to speak to the overall durability of the procedure. Three patients required repeat intervention because of recurrent symptoms. Successful repeat angioplasty or stent placement was obtained in two of three patients. One patient eventually required surgical bypass for the SVC obstruction. The prior stent placement did not contribute to surgical complications at the time of bypass.

cheer

[Cece]

awesome, cheer - that is a better comparison.

Sadly there was still an anticoagulation fatality in that one too:

Complications from the interventional procedures included stent migration at the time of initial expansion with partial right atrial deployment in two patients and penetration of the SVC and pericardial space in one patient. The patient with SVC penetration did not suffer tamponade or cardiovascular compromise and did not require evacuation of pericardial hematoma. One patient with partial right atrial deployment was treated with anticoagulation long-term due to concerns of thrombus formation from the malpositioned stent. The second patient was treated with aspirin alone. Neither of the patients with stent malposition have experienced complications since the time of the intervention. There were no bleeding complications documented during thrombolysis. One patient died 24 months following treatment from a subdural hematoma related to the use of anticoagulation.

But I'm reading that as the patient was kept on anticoagulants for 24 months, far longer than what we are dealing with.