[Percutaneous transluminal treatment of stenoses and obstructions in the venous system using vascular endoprostheses (stents)].

Abstract

Benign and malignant obstructions of the superior and inferior V. cava and large central veins are often difficult to treat by conservative and surgical means. In this overview we report a new technique which keeps obstructed veins patent by means of percutaneously-inserted metal endoprostheses. The technique allows rapid and lasting relief of the clinical signs of venous inflow obstruction. The high clinical success rate and longterm patency of 70 to 100% in malignant stenoses, and close to 100% in benign obstruction, makes this technique the method of choice for treating superior and inferior inflow obstructions secondary to diseases of the V. cava and the pelvic and brachiocephalic veins. Patients suffering from malignancies benefit in particular from rapid improvement of their quality of life using an effective method with a low complication rate. Vascular stents may also be used in venous outflow stenosis of hemodialysis shunts. However, because of the high recurrence rate secondary to intimal hyperplasia, particularly in peripheral stenoses in the region of the arm, we recommend a conservative attitude. The use of stents is only indicated after one or more trials with conventional balloon angioplasty.