obstruction of the superior vena cava ( svc ) is a recognized complication of lung cancer . before the mid twentieth century , malignancy accounted for one - third of all cases of svc syndrome ( svcs ) . today , however , intrathoracic malignancy has far surpassed benign disease as the primary cause of svc obstruction . approximately 73 to 97% of svcs cases occur secondary to malignancy , and the most frequent cause is lung malignancy . approximately 3 to 5% of patients with lung malignancy develop the syndrome ( 2 ) . obstruction of the svc occurs either via direct extension or compression due to the primary tumor or via invasion of the mediastinal lymph nodes . in addition , progressive tumor growth may violate the vascular intima and serve as a nidus for thrombus formation , which can evolve to extensive thrombosis of vessels . svc syndrome due to malignancy produces acute distress and degrades the quality of life during the limited survival . therefore , the goal of svcs therapy is rapid and effective palliation of the symptoms , rather than long - term remission . traditionally , most patients with svcs secondary to malignancy have been treated non - operatively , with radiotherapy , chemotherapy , or both . with radiotherapy , diminished venous distension and subjective improvement approximately 46 to 70% of patients with bronchogenic carcinoma will demonstrate a symptomatic response to radiotherapy or combined radiotherapy and chemotherapy within the first two weeks ( 3 , 4 ) . prompt , persistent resolution of symptoms is achieved in 75 to 95% of patients ( 5 , 6 ) . this paper reviews our experience in treating svcs to assess the effectiveness of endovascular stenting for palliation of svcs . between september 2001 and february 2003 , percutaneous endovascular stent ( wall stent , boston scientific , nastick , ma , u.s.a . ) insertion was attempted in 10 patients ( 8 men , 2 women ) , age range 37 - 63 ( mean 54 ) yr , with symptomatic occlusion of the svc . wall stents varied in length ( 4 - 10 cm ) and diameter ( 10 - 14 mm ) . all patients had known malignant disease of thorax ( squamous cell carcinoma : 4 , adenocarcinoma : 3 , poorly differentiated carcinoma : 3 ) . eight patients had been treated previously with chemotherapy and radiotherapy ( n=5 ) , chemotherapy alone ( n=2 ) , or pneumonectomy and radiotherapy ( n=1 ) . after developing svcs , the svc was stenosed or occluded in all cases by tumor and thrombotic occlusion of the svc . venous access was achieved via the right jugular vein in four patients , via the left jugular vein in one patient , and via the right femoral vein in five patients . after navigating the stenosed or occluded segment of the svc with a angiographic catheter and guidewire , primary clinical patency was defined as the resolution of edema after the procedure ; if another procedure was needed to relieve svcs , it was recorded as secondary clinical patency . after stenting , five patients were treated with either chemoradiation ( n=2 ) or chemotherapy alone ( n=3 ) . retrospective analysis of the clinical records was used to assess the effectiveness of endovascular stenting for the palliation of svcs . , symptoms due to thrombosis recurred in two of nine patients after 15 or 60 days ; both were successfully resolved by repeated stenting ( fig . these two patients took part early in the trial , when we did not use anticoagulation or antiplatelet therapy . subsequently , warfarin 5 mg and acetyl salicylic acid 300 mg were used to prevent thrombosis . symptom - free survival ranged from 12 days to 14 months ( mean 6.7 months ) . presently , five patients are alive , remain asymptomatic , and have a patent stent . five patients have died from their cancers ; however , they remained free of symptoms of svc occlusion until death . superior vena cava syndrome generally occurs as a result of either compression by an adjacent tumor or compression by lymph nodes . a tumor invades the vena cava much less frequently in advanced stages of disease ( 7 ) . the response to therapy in patients with lung malignancy and svcs may have an impact on survival . in one series , those who did not respond to non - operative therapy within 30 days had a significantly lower one - year survival ( 7% ) than those who responded to therapy ( 17 to 24% ) . patients who received no therapy or who developed changes in mentation and compromised airways had a median survival of only six weeks ( 3 , 8 , 9 ) . general medical treatment ( i.e. , bed rest , elevation of the head , diuretics , steroids , and anticoagulation ) is of limited clinical benefit ( 2 ) . radiation therapy is widely advocated for svcs caused by radiosensitive tumors and provides relief by reducing tumor volume ( 10 ) . radiotherapy and chemotherapy are the standard forms of treatment , and a combination of the two has been used ( 11 ) . symptom improvement of 75 - 90% has been reported , although other studies have obtained less promising results ( 46% success with radiation therapy for non - small cell carcinoma and 62 - 80% with chemotherapy for small cell carcinoma ) ( 11 , 12 ) . traditional therapies require 2 - 4 weeks to show an effect ( 11 , 13 ) . furthermore , svcs recurs in 20 - 50% of cases and only symptomatic treatment is possible . since these affect the quality of life of a patient whose life expectancy is only 6 months , they may be considered unacceptable and counterproductive , as radiation therapy can induce fibrotic changes that further constrict the vessels . ( 14 ) introduced endovascular stenting in dogs to treat obstruction of the vena cava , the development of endovascular stenting has continued . complications are minimal and , in terms of symptom relief , the results are encouraging . the wall stent is the most common endovascular device used to treat svcs , although the palmaz and gianturco stents have also been used with success . we attempted percutaneous endovascular stent ( wall stent , boston scientific , nastick , ma , u.s.a . ) insertion in 10 patients . symptom improvement usually occurred within 48 - 72 hr of stent placement and , 90% of patients remained symptom - free until death , as compared with only 12% of those who were treated with palliative radiation therapy . they concluded that stent placement was a more effective palliative therapy and recommended stenting as the procedure of choice . in the cochrane systematic review ( 15 ) of treatment for malignant svc obstruction , stent insertion provided relief of symptoms more rapidly , and in a higher proportion of patients ( 95% ) than did radiation therapy or chemotherapy . others have reported success rates of 90 to 100% in patients with malignancy - related svcs treated with combined endovascular therapy ( thrombolysis , angioplasty , and stent placement ) ( 16 ) . kee et al . ( 6 ) reported technical success in 56 of 59 patients ( 95% ) , primary clinical patency was 79% , and secondary clinical patency was 93% with mortality and morbidity rates of 3 and 10% , respectively . in our patients , initial clinical success was achieved in 90% ( 9/10 ) . , symptoms due to thrombosis recurred in two of nine patients after 15 or 60 days ; both were successfully resolved by repeated stenting . in our patients , 17 ) reported no recurrences in 13 patients , with follow - ups ranging from 3 to 180 days . ( 18 ) had 1 recurrence in a group of 20 patients , with follow - ups ranging from 1 to 11 months . , symptoms recurred in two of nine patients ( 22.2% ) after 15 and 60 days , both were thrombotic occlusions and were relieved by placement of another stent . the most common complication of this therapy is stent thrombosis , which has been successfully treated with thrombolysis or further stent insertion ( 19 ) . early ( within one month of stenting ) thrombosis occurs in 8 - 20% and late ( more than one month after endovascular stenting ) thrombosis occurs in 5 - 45% . thrombosis is significantly reduced when long - term anticoagulation ( warfarin , platelet inhibitors ) is used following endovascular stenting ( 17 ) . after we experienced one early and another late thrombosis , we began to use warfarin and platelet inhibitors . since no thrombosis occurred during the long - term follow - up period , this treatment seems adequate to prevent further thrombosis . in summary , our results with endovascular stents in the initial treatment of svcs of malignant cause were excellent . endovascular stent insertion is the first choice of treatment as it produces immediate relief of symptoms and excellent sustained symptomatic relief .
to assess the effectiveness of endovascular stenting for the palliation of superior vena cava ( svc ) syndrome , endovascular stent insertion was attempted in 10 patients with symptomatic occlusion of the svc . 
 all the patients had known malignant disease of the thorax . 
 eight patients had been treated previously with chemotherapy and radiotherapy ( n=5 ) , chemotherapy alone ( n=2 ) , or pneumonectomy and radiotherapy ( n=1 ) . after developing svc syndrome , 
 all the patients were stented before receiving any other treatment . 
 after single or multiple endovascular stents were inserted , five of eight patients were treated with chemotherapy and radiotherapy ( n=2 ) or chemotherapy alone ( n=3 ) . 
 resolution of symptoms was achieved in nine patients within 72 hr ( 90% ) . in one patient , 
 the symptoms did not disappear until a second intervention . at follow up 
 , symptoms had recurred in two of ten patients ( 20% ) after intervals of 15 and 60 days . 
 five patients have died from their cancers , although they remained free of symptoms of svc occlusion until death . in conclusion 
 , endovascular stent insertion is an effective treatment for palliation of svc syndrome . 
 endovascular stent insertion can be considered the first choice of treatment , due to the immediate relief of symptoms and excellent sustained symptomatic relief .